Professional Documents
Culture Documents
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Collaborative Members
California Hospital Medical Center Lynn Yonekura, M.D., Director of Community Benefits
Childrens Hospital Los Angeles Ellen Zaman, Director of Community Affairs
Good Samaritan Hospital Sammy Feuerlicht, Vice President, Strategic Planning and Development and Tom Baumann, Director, Physician
Development
Kaiser Foundation Hospital, Los Angeles Mario Ceballos, Community Benefit Manager
St. Vincent Medical Center Jan Stein, Vice President and Executive Director, St. Vincent Foundation
The Community Needs Assessment, as part of the SB697 requirements, was conducted by the Center for Nonprofit Management.
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
The primary service area of SVMC includes all or portions of the SPAs, Health Districts, cities and communities, and 21 zip codes:
Service Planning Areas
SPA 4 Metro Los Angeles
SPA 6 South
Health Districts
HD 9 Central
HD 34 Hollywood/Wilshire
HD 47 Northeast
HD 69 South
HD 72 Southeast
HD 75 Southwest
Cities/Areas
Crenshaw
Echo Park
Hollywood
Northeast Los Angeles
Pico Union
South Central
West Hollywood
Westlake
Wilshire
90004
90005
90006
90007
90008
90010
90011
90016
90017
Zip Codes
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Table of Contents
23
23
1
2
Service Area...
Population Data..
2.1 Population count..
2.2 Age.
2.3 Citizenship
2.4 Education attainment..
2.5 Race/ethnicity...
2.6 Households..
2.7 Language spoken at home...
2.8 Marital status....
2.9 Foster care population.
2.10 Poverty rate.
2.11 Household income (median).
2.12 Class of workers by industry
2.13 Employment status, including unemployment.
2.14 Means of transportation to work.
Natality
3.1 Prenatal care..
3.2 Birth weight.
3.3 Births by Zip Code
3.4 Birth by mothers race/ethnicity and age ...............................................................
Mortality
4.1 Deaths.
4.2 Cause of death..
23
23
23
24
25
26
28
29
31
31
32
34
37
38
38
40
40
40
41
42
43
47
47
50
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
4.3
Premature death.
51
B. ACCESS.. 52
1 Health Insurance..
1.1 Type and status..
1.2 Healthy Families disenrollment..
2 Regular Source of Care.
2.1 DHS use in the past year
3 Specialty Care .
3.1 Special health care needs
4 Emergency Room Use
4.1 Emergency room use for children.
5 Barriers to Access.
5.1 Difficulty in accessing care.
5.2 Could not afford to see a Medical Doctor..
5.3 Could not afford mental health care..
5.4 Could not afford dental care.
5.5 Could not afford eyeglasses..
5.6 Could not afford medication (Rx) .
5.7 Transportation barrier..
5.8 Language barrier...
6 Senior Care
7 Community Clinics
8 Disability
52
53
54
55
55
55
57
58
59
60
60
62
62
62
62
62
66
67
68
70
72
Childhood Immunization..
Influenza and Pneumonia Vaccinations among Elderly Adults ...
Cholesterol Screening..
Dental Care.
75
77
78
79
6
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
5
6
Health Literacy.
Fitness and Nutrition.
6.1 Physical activity..
6.2 Limited activity (number of days) ...
6.3 5 servings of fruits and vegetables...
6.4 Breakfasts (daily consumption) .
6.5 Fast food.
D. RISK BEHAVIORS..
1
2
4
5
6
Obesity.
1.1 Overweight and obesity...
Smoking.
2.1 Established smokers...
2.2 Smoke exposure.
Alcohol use..
3.1 Binge drinking..
3.2 Chronic drinking.
Drug use.
Youth involved in Gangs..
Youth arrest/felonies..
E. CHRONIC DISEASES......
1
2
3
4
5
6
Diabetes...
Asthma..
2.1 Childhood Asthma Hospitalization Rate.
Heart Disease.
Arthritis.
High blood cholesterol .......................
Hypertension/high blood pressure.
80
81
81
83
83
85
86
87
87
87
89
89
91
92
93
94
94
95
96
97
97
99
101
101
102
103
103
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
F. CANCER..
1
2
3
4
104
104
105
106
107
G. HIV/AIDS......
108
HIV/AIDS..
1.1 HIV/AIDS, for Adolescents..
108
110
H. COMMUNICABLE DISEASES...
111
1
2
3
4
5
6
I.
J.
Tuberculosis....
Hepatitis A..
Hepatitis B..
Hepatitis C...
Pertussis ..
Sexually Transmitted Infections...
111
113
113
114
115
MENTAL HEALTH....
117
118
1
2
3
4
118
119
120
122
123
1
2
3
4
5
6
123
127
128
128
130
131
Domestic Violence .
Child Abuse and Neglect..
Teenage Pregnancy..
Immigration......
School dropouts...
Self reported health status..
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
7
8
9
10
11
12
13
14
15
16
17
18
19
20
131
132
132
133
134
134
136
137
138
140
141
142
142
143
143
144
145
146
147
149
150
151
154
155
155
164
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
List of Figures
Figure
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
10
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
11
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
Percentage of Adults (18+ years) Who Completed the Survey Interview in a Non English Language in the Past Year and Who Also
Reported Difficulty Talking to a Doctor or Health Care Professional Because of a Language Barrier by SPA, 2007
California Population Age 60+ Growth Trends (in Millions), 2007
Primary Care Clinic Demographic & Utilization Information, Los Angeles County, 2007
Primary Care Clinic Selected Procedural Information, Los Angeles County , 2007
LA County DHS and PPP Program Providers Primary Care Clinic Selected Procedural Information by SPA, 2007
Disability Percentage Prevalence by State, 2008
Estimated Vaccination Coverage for Vaccination Series (modified)* and Selected Individual Vaccines Among Children aged 19 35
Months by State and Local Area National Immunization Survey, United States, 2009
Percentage of Adults (65+ years) Reported Receiving a Flu Shot in the Past 12 Months by SPA, 2007
Percentage of Adults (65+ years old) Reported Ever Having a Pneumonia Vaccination by SPA, 2007
Percentage of Adults (18+ years) Diagnosed with High Blood Cholesterol by SPA, 2007
Prevalence of Physical Activity for Adults (18+ years) by SPA, 2007
Average Days in the Past 30 Days of Limited Activity Due to Poor Physical and/or Mental Health for Adults (18+ years) by SPA, 2007
Percentage of Those Consuming 5 Fruits and Vegetables Per Day (Population 5 and Over) in SVMCs Primary Service Area, 2005
Percentage of Adults (18+ years) Reported Having Eaten 5 or More Servings of Fruits/Vegetables in the Past Day by SPA, 2007
Percentage of Parents of Children (2 17 Years Old) Who Reported Their Child Ate Breakfast Daily in a Typical Week by SPA, 2007
Percentage of Children (2 17 Years Old) Who Ate Fast Food Yesterday by SPA, 2005
Percentage of Overweight and Obese (12+ years) by SPA, 2007
Overweight and Obese (12+ years) in SVMCs Primary Service Area, 2005
Percentage of Adults (18+ years old) who Smoke Cigarettes by SPA, 2005
Percentage of Adults (18+ years) Who Are Current, Non Regular, Former and Non Smokers by SPA, 2007
Percentage of Parents of Children (0 17 Years) Who Reported Their Child Exposed to Tobacco Smoke in the Home by SPA, 2005
Percentage of Adults (18+ years) Who Reported Drinking Alcohol in the Past Month by SPA, 2007
Percentage of Adults (18+ years) Who Reported Binge Drinking* in the Past Month by SPA, 2007
Percentage of Adults (18+ years) Who Reported Chronic/Heavy Drinking* in the Past Month by SPA, 2007
Percentage of Adults (18+ years) Who Reported Receiving Treatment (in the past 5 years) for Substance Abuse or Addiction by SPA,
2007
12
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
13
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
Percentage of Children (3 17 years) Unable to Afford Mental Health Care or Counseling in the Past Year by SPA, 2007
Number of Alcohol and Drug Related Mental Illness Cases in SVMCs Primary Service Area, 2007
Percentage of Adult (18+ years) Diagnosed with Depression in SVMCs Primary Service Area, 2007
Percentage of Adults (18+ years) Diagnosed with Depression by SPA, 2007
Percentage of Children (3 17 Years) Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) by SPA, 2007
Domestic Violence Death Due to Homicide Among Females (ages 10 44 years), 2006
Domestic Violence Hospitalizations Due to Violent Injuries Among Females (ages 13 and over), 2006
Domestic Violence Adult Arrests for Spousal Abuse, 2006
Domestic Violence Related Calls for Assistance in the Adult Population (age 18 and over), 2006
Domestic Violence Related Calls for Assistance Involving Weapons, 2006
Substantial Maltreatment Reports for Children Less Than One Year, Rate per 1,000 children, 2008
Foreign Born Population in Los Angeles County 2008 estimates
Foreign born population by Age Group in Los Angeles County, 2006 2008
High School Dropout Rates by California County, 2008
Percentage of Adults (18+ years old) who Reported Fair/Poor Health Status by SPA, 2007
Average Number of Unhealthy Days (Mental and/or Physical) in the Past 30 days for Adults (18+ years) by SPA, 2007
Protected Areas per 1,000 People (Acre) in SVMCs Primary Service Area, 2009
Number of Households by SPA, 2009
Number of Households by SVMCs Primary Service Area, 2009
Occupied and Vacant Units in SVMCs primary service, 2010
Owner occupied vs. Renter occupied Housing Units in SVMCs Primary Service Area, 2010
Owner vs. Renter Occupied Housing Units by SPA, 2010
Units in Structure in SVMCs Primary Service Area, 2010
Units in Structure by SPA, 2010
Owner occupied Median Home Values in SVMCs Primary Service Area, 2010
Number of Passenger Cars, Vans, and Pickup/Panel Trucks Kept at Home and Available for Transportation
Homicides by Firearm in SVMCs Primary Service Area, 2006
14
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
127. Percentage of Children (1 17 Years Old) whose Parents Reported Easy Access to a Park, Playground or Other Safe Place for Recreation
by SPA, 2007
128. Downtown Los Angeles Residential Race/Ethnicity, 2006 & 2008
129. Los Angeles Continuum of Care by Sheltered and Unsheltered Persons by SPA, 2009
130. Los Angeles Continuum of Care by Gender and Ethnicity, 2009
131. Trends in Food Insecurity among Households by SPA, 2007
132. Percentage of Adults Diagnosed with diabetes or borderline/pre diabetes by SPA, 2009
133. Number of Alcohol Distributors in SVMCs primary service area, 2009
134. Number of Alcohol Distributors in SVMCs Primary Service Area, 2009
135. Percentage of Adults who Reported Binge Drinking* in the Past Year, 2009
136. Number of Alcohol Outlets per 1,000 in SVMCs Primary Service Area, 2009
137. Focus group characteristics, 2010
138. Health issues/trends identified by focus group participants
139. Health services that are lacking identified by focus groups
140. Barriers to health care identified by focus groups
141. How to address barriers identified, from two focus groups
142. Healthy behaviors hardest to promote
143. What preventative health care means to focus group participants
144. Where do people go for information on health services
145. Role hospitals could play
146. Non health community issues identified in focus groups
147. Health related issues identified by key informants
148. Health needs identified by key informants
149. Barriers to health care services identified by key informants
15
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Appendices
Appendix
1. Sources
2. Percent of Adults (18+ years old) Reported Having a Regular Source of Health Care by Health District, 2007
3. Percent of Adults (18+ years old) Reported Received Medical Services from LA County Health Department Facilities in the Past Year by
Health District, 2005
4. Percent of Children (0 17 years old) who Meet Criteria for Having Special Health Care Needs (SHCNs)11 by Health District, 2005
5. Percent of Adults (18+ years old) Who Reported That Obtaining Medical Care When Needed Is Somewhat or Very Difficult by Health
District, 2007
6. Percent of Adults (18+ years old) Unable to See a Doctor for a Health Problem When Needed in the past year Because They Could Not
Afford It by Health District, 2007
7. Percent of Adults (18+ years old) Unable to Receive Mental Health Care or Counseling When Needed in the Past Year Because Could Not
Afford It by Health District, 2007
8. Percent of Adults (18+ years old) Unable to Obtain Dental Care (Including Check Ups) in the Past Year Because They Could Not Afford it
by Health District, 2007
9. Percent of Adults (18+ years old) Unable to Obtain Eyeglasses When Needed in the Past Year Because They Could Not Afford It by Health
District, 2005
10. Percent of Adults (18+ years old) Who Reported Did Not Get Prescription Medication When Needed in the Past Year Because Could Not
Afford It by Health District, 2007
11. Percent of Adults (18+ years old) Unable to Obtain Dental Care (Including Check Ups) in the Past Year Because They Could Not Afford it
by Health District, 2007
12. Percent of Adults (18+ years old) Reported Transportation Problems Kept Them from Obtaining Needed Medical Care in the Past Year by
Health District, 2007
13. Percent of Adults (18+ years old) who Completed the Survey Interview in a Non English Language in the Past Year and who also Reported
Difficulty Talking to a Doctor or Health Care Professional Because of a Language Barrier by Health District, 2007
14. Percent of Adults (65+ years old) who Reported Receiving a Flu Shot in the Past 12 Months by Health District, 2007
16
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
15. Percent of Adults (65+ years old) Reported Ever Having a Pneumonia Vaccination by Health District, 2007
16. Percent of Adults (18+ years old) Diagnosed with High Blood Cholesterol by Health District, 2007
17. Prevalence of Physical Activity for Adults (18+ years old) by Health District, 2007
18. Average Days in the past 30 days of Limited Activity Due to Poor Physical and/or Mental Health for Adults (18+ years old) by Health
District, 2007
19. Percent of Parents of Children (2 17 Years Old) who Reported Their Child Ate Breakfast Daily in a Typical Week by Health District, 2007
20. Percent of Children (2 17 Years Old) Who Ate Fast Food Yesterday by Health District, 2005
21. Percent of Adults (18+ years old) who Smoke Cigarettes by Health District, 2005
22. Percent of Adults (18+ years old) Reported Established Cigarette Smoker (Smoked at Least 100 Cigarettes and Currently Smokes) by
Health District, 2007
23. Percent of Parents of Children (0 17 Years Old) Who Reported Their Child Exposed to Tobacco Smoke in the Home by Health District,
2005
24. Percent of Adults (18+ years old) who Reported Drinking Alcohol in the Past Month by Health District, 2007
25. Percent of Adults (18+ years old) who Reported Binge Drinking3,3a in the Past Month by Health District, 2005
26. Percent of Adults (18+ years old) who Reported Chronic Drinking3 in the Past Month by Health District, 2005
27. Percent of Adults (18+ years old) Diagnosed with Heart Disease by Health District, 2007
28. Percent of Adults (18+ years old) Diagnosed with Arthritis by Health District, 2005
29. Percent of Adults (18+ years old) Diagnosed with Hypertension by Health District, 2007
30. Percent of Adults (18+ years old) Diagnosed with High Blood Cholesterol by Health District, 2007
31. . Percent of Adults (50+ years old) Reported Having a Blood Stool Test within the past 2 years by Health District, 2005
32. Percent of Adult Women (18+ years old) Reported Having a Pap Smear by Health District, 2007
33. Percent of Women (40+ years old) Reported Having a Mammogram in the Past 2 Years by Health District, 2007
34. Percent of Women (50+ years old) Reported Having a Mammogram in the Past 2 Years by Health District, 2007
35. TB Cases by Health District, 2007
36. Trend of Chlamydia, Gonorrhea, Syphilis Reported for Los Angeles County Residents, 2004 2008
17
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
37. Reported Chlamydia Cases and Rates per 100,000 Population by Service Planning Area (SPA)1 and Health District (HD), Los Angeles
County, 2004 2008
38. Reported Gonorrhea Cases and Rates per 100,000 Population by Service Planning Area (SPA)1 and Health District (HD), Los Angeles
County, 2004 2008
39. Reported Primary and Secondary Syphilis Cases and Rates per 100,000 Population by Service Planning Area (SPA)1 and Health District
(HD), Los Angeles County, 2004 2008
40. Percent of Children (3 17 years old) whose Parents Reported They Were Unable to Afford Mental Health Care or Counseling for Their
Child in the Past Year by Health District, 2007
41. Percent of Adults (18+ years old) Diagnosed with Depression by Health District, 2007
42. Percent of Adults (18+ years old) who Reported Fair/Poor Health Status by Health District, 2007
43. Average Number of Unhealthy Days9 (Mental and/or Physical) in the past 30 days for Adults (18+ years old) by Health District, 2007
44. 2009 to 2010 Median Home Values by Metro Collaborative Cities by Health District, 2010
45. Percent of Children (1 17 Years Old) whose Parents Reported Easy Access to a Park, Playground or Other Safe Place for their Child to Play
by Health District, 2007
18
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
19
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Organization of Report
This report summarizes key quantitative and qualitative findings for the Los Angeles Metro Collaborative. Specific demographic community
profiles are summarized for SVMC. Overall, findings are organized in narrative and graphic formats by Service Planning Area (SPA), and/or zip
codes. Findings are organized by the following major content areas:
Community Health Profile
Health Access
Health Behaviors and Preventative Care
Risk Behaviors
Chronic Diseases
Cancer
HIV/AIDS
Communicable Diseases
Mental Health
Community and Social Issues
20
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Methods
As in the assessments conducted for the hospital collaborative in 2004 and in 2007, CNMs approach was to emphasize the central importance of
input from knowledgeable, involved community stakeholders. These key informants are a preferred alternative to a community survey, since
a scientific (probability) sample community survey of sufficient size and response rate would not be feasible, affordable, or as effective.
Community leaders who could represent community interests more efficiently and accurately than a community survey were identified by the
hospitals. Leaders and managers from participating hospitals and community based agencies participated by sharing their perceptions about
the landscape of health care needs and barriers in their communities. Other community members and service recipients chosen by community
based agencies provided a broader and more precise perspective about health care services, gaps in services, and suggestions about how to fill
them. Key informants added important knowledge and experience for their target areas. Their input made it possible to conduct an informative
needs assessment with direct implications for policies and resource allocation to meet the individual member hospitals specific priorities.
In addition, the team complemented this qualitative approach with the compilation and analysis of secondary data. Because Census 2010 data
was not available, 2009 Claritas/Nielsen projection data were used for general demographics and were compiled by Service Planning Areas
(SPAs), and zip codes when available. Existing data was also utilized from the Los Angeles County Department of Health Services for
health/community need indicators, capacity needs or barriers, and benchmarking standards. Most of the quantitative data for the 2010 needs
assessment was culled from the latest Los Angeles County Health Survey and are available by SPAs and HDs. Because the Health Survey has
been implemented regularly, we were also able to detect trends in the various geographies going back as far as 1997 for most indicators.
Additional data sources were mined as part of the literature review process during the early phase of the needs assessment
Document Reviews
Existing data and data sources were reviewed with the hospital collaborative to identify which data variables would be most helpful in setting
priorities for each individual member hospital. Additionally, staff reviewed administrative data.
21
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
needs assessment were prioritized. These groups included residents from major ethnic groups, geographic areas and service providers in the
Collaboratives primary service areas. Residents from ethnic communities were African American and Latino, representing areas of downtown
Los Angeles, East Los Angeles and other metro areas. Translation was provided in the Latino focus groups. Seniors, community health
promoters and service providers were gathered separately. Ten focus groups were conducted to cover the number of communities served by
the hospital collaborative. A majority of these focus groups were done with community residents identified by community agencies involved in
previous needs assessments and by the collaborative. Two focus groups included representatives of community agencies and service providers
who interacted with residents on issues related to health care.
Interviews Thirty interviews were conducted to gather information about the needs and challenges faced by the community in accessing and
utilizing health care services. Thirty key informant interviews were conducted to ensure reliable and representative information. Key
informants included staff at collaborative hospitals and health care service organizations in the primary service areas. Interviews were
conducted over the phone or in person and lasted approximately 45 minutes.
22
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
I. Quantitative
A.
1. Service Area
St. Vincent Medical Center (SVMC) provides health services to individuals residing in twenty one zip codes within two of the eight Service
Planning Areas (SPAs) throughout Los Angeles County. Please note that from this point on St. Vincent Medical Center will be referred to as
SVMC.
2. Population Data
2.1 Population Count
In 2009, the U.S. Census Bureau reported an estimated total Los Angeles County population of 9,848,011 residents (U.S. Census, 2010). Of the
total County population, about 11.3% (or 1,114,255 individuals) resided within the SVMCs (Nielsen Claritas, Inc., 2010). The highest populated
zip code within SVMC is 90011 at 108,722 residents, followed by zip code 90044 with 92,871 residents (Nielsen Claritas, Inc.). In contrast, the
least geographically populated zip codes serviced are zip codes 90010, with 2,215, and 90017 with 27,700 residents (Nielsen Claritas, Inc.).
Figure 1. SVMC Service Zip Codes and Population for 2009
Zip Code
Population
90004
70,525
90005
46,215
90006
67,475
90007
46,513
90008
31,499
90010
2,215
90011
108,722
90016
49,427
90017
27,700
90018
50,504
Zip Code
Population
90020
47,190
90026
74,633
90027
51,079
90028
31,576
90029
44,380
90031
40,555
90037
60,210
90044
92,871
90046
51,428
90057
49,960
90019
70,215
Population Count
571,010
Population Count
543,882
1,114,892
10,022,189
By SPA, the largest populated area is San Fernando, followed by San Gabriel, and the South Bay. The least populated SPA is West. Population
statistics and proportions for each SPA are detailed in Figure 2 below.
23
Figure 2. Po
opulation by SPA
A, 2010
Number of
Householdss
9,848,011
Percenttage of Los
Angele
es County
10
00%
S
Service
Planning Area
A
S Fernando (2)
San
2,106,690
21
1.4%
S Gabriel (3)
San
1,836,622
18
8.6%
Metro (4)
1,207,063
2.3%
12
West (5)
W
654,766
6.6%
SSouth (6)
971,522
9.9%
East (7)
1,322,122
3.4%
13
1,515,367
15
5.4%
2.2 Age
Children and youth (ages 0 17) accounted for moree than one quarter (26.5%) of thee population in SV
VMCs primary seervice area, includ
ding almost
8% who were und
der the age of 5. Less than 1 in 10
0 people in this population were age 65 and abovee. Please see Figu
ure 3 for more daata.
24
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
16.2%
15%
10%
5%
6.1%
7.0%
5.9%
4.9%
4.7%
3.6%
2.9%
1.3%
0%
It should be noted that in 2030, when all of the baby boomers reach 65 and older, they will make up nearly one in five U.S. residents. Sixty five
and older populations are expected to double in size by year 2050 to 88.5 million from 38.7 million in 2008. Eighty five and older populations are
expected to more than triple, from 5.4 million to 19 million between 2008 and 2050.
Few focus group and interview participants discussed the increasing proportion of the aging population, as the baby boomer generation gets
older and advocated expansion of services for this population.
2.3 Citizenship
The United States is projected to be more racially diverse and much older by the midcentury mark. The U.S. Census Bureau projections report
that immigrants arriving to the county after 1990, including their children, are expected to make up two thirds of the population growth in the
U.S. between 2000 and 2050, when the total population will increase from 281 million to 404 million. Estimates indicate that these immigrants
and their children will comprise more than one out of every four American residents in the year 2050.
The Census 2008 National Population Projections highlights that minorities will become the majority in 2042 and by the year 2023 minorities will
comprise more than half of all children.
25
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
According to the 2009 American Community Survey, of the estimated 307,006,556 people living in United States, 86.1% of the population were
U.S. citizens born in the United States, 5.5% were U.S. citizens by naturalization and 7.1% were not a U.S. citizen. In California 28.4% are
naturalized citizens. However, nearly half (47.4%) of Californias naturalized citizens are from Los Angeles, Long Beach and Santa Ana1.
Throughout the years, that rate has remained steady.
Figure 4. Persons Naturalized Nationally, Statewide and by Core Based Statistical Area (CBSA) of Residence, 2009
Percentage of the U.S.
34.1%
169,126
Percentage of
California
56.0%
202,668
33.4%
96,852
47.8%
572,646
149,213
26.1%
69,495
46.6%
2003
462,435
135,599
29.3%
62,556
46.1%
2004
537,151
145,593
27.1%
66,733
45.8%
2005
537,151
170,489
31.7%
78,182
45.9%
2006
702,589
152,836
21.8%
65,811
43.1%
2007
660,477
181,684
27.5%
78,454
43.2%
2008
1,046,539
297,909
28.5%
138,618
46.5%
2009
743,715
179,754
24.2%
84,061
46.8%
6,754,988
1,917,652
28.4%
909,888
47.4%
Year
United States
2000
886,026
California
301,907
2001
606,259
2002
Total
Source: Department of Homeland Security, Office of Immigration Statistics, Yearbook of Immigration Statistics 2009
Department of Homeland Security, Office of Immigration Statistics, Yearbook of Immigration Statistics 2009
26
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Less Than HS
Diploma
N
%
19141
41.7%
13866
46.1%
24856
61.2%
12367
54.9%
4134
19.8%
340
21.3%
41559
73.9%
11851
38.9%
11766
73.0%
14016
45.6%
16865
36.3%
8749
27.2%
21626
44.6%
9022
22.9%
6978
30.0%
13609
47.3%
15461
64.3%
20644
62.8%
27598
54.7%
17575
56.7%
312023
47.9%
19141
41.7%
HS or equivalent
N
%
8093
17.6%
5202
17.3%
6907
17.0%
2952
13.1%
4032
19.3%
297
18.6%
7452
13.3%
6539
21.4%
2208
13.7%
5979
19.5%
8111
17.5%
6890
21.4%
7855
16.2%
6998
17.8%
4216
18.1%
5606
19.5%
3586
14.9%
5647
17.2%
10691
21.2%
5078
16.4%
114339
17.5%
8093
17.6%
Bachelors degree
or higher
N
%
9977
21.7%
5927
19.7%
3645
9.0%
3843
17.0%
5188
24.8%
548
34.3%
1532
2.7%
3744
12.3%
744
4.6%
3179
10.3%
9675
20.8%
9347
29.1%
9987
20.6%
13856
35.2%
6171
26.6%
4201
14.6%
1697
7.1%
1357
4.1%
2400
4.8%
3947
12.7%
100965
15.5%
9977
21.7%
1979475
1205647
1535654
31.0%
18.9%
24.1%
SPA data reveal that a majority of SPAs had a higher rate of educational attainment than Los Angeles County. In SVMCs primary service areas
the majority has less than a high school level of educational attainment (32.6% in SPA 4 and 45.5% in SPA 6).
27
Fiigure 6. Educatio
onal Attainment by SPA, 2010
Less than High School
High Schoo
ol or Equivalent
Some College/A
Associates Degree Bachelors Degre
ee or Higher
1,606,15
25.0%
1,383,744
21.5%
1,648,738
25.7%
1,789,061
27.8%
274,66
61
19.8%
287,897
20.8%
378,545
27.3%
445,642
32.1%
261,98
83
22.2%
254,576
21.6%
313,935
26.6%
349,508
29.6%
Metro (4)
M
264,85
51
32.6%
158,027
19.4%
166,289
20.4%
223,991
27.5%
West (5)
W
36,26
61
7.5%
62,095
12.8%
113,331
23.3%
274,932
56.5%
SSouth (6)
244,77
76
45.5%
125,261
23.3%
115,330
21.4%
52,526
9.8%
EEast (7)
266,96
66
33.6%
206,861
26.1%
195,606
24.6%
124,169
15.6%
207,51
15
21.5%
212,544
22.1%
269,168
27.9%
274,445
28.5%
2.5 Race/Ethnicity
In the SVMC prim
mary service areaa, the majority off the population were Hispanic/Laatino (58.7%) followed by African
n American or Blaack (13.9%),
and then White (13.2%). In Los Angeles County, the Hispanic/Latino subgroup also
o made up the majority of the po
opulation (48.1%)). However,
the second largesst subset of the population in Los Angeles County in 2009 was Whitte (27.4%), follow
wed by the Asian subgroup (12.8%
%).
Figure 7. Race/EEthnicity Percenttages in SVMCs Primary Service Area, 2009
Race/Ethniccity
White
Black or African Am
merican
American Indian an
nd Alaskan Native
Asian
Native Hawaiian an
nd Pacific Islander
Some Other Race
Two or More Racess
Hispanic/Latino
Total
SVMC
C
147,150 (13
3.2%)
155,101 (13
3.9%)
2,326 (0.2
2%)
129,362 (11
1.6%)
701 (0.1%)
2,375 (0.2
2%)
22,953 (2..1%)
653,927 (5
58.7)
1,114,255 (100.0%)
Lo
os Angeles County
2,750,423 (27.4%)
857,211 (8.6%)
22,890 (0.2%)
1,286,101 (12.8%)
22,420 (0.2%)
19,610 (0.2%)
245,452 (2.5%)
4,818,082 (48.1%)
10
0,022,189 (100.0%))
28
2.6 Households
Of the 13 million households in th
he state (12,652,2
259) of Californiaa, one in four hou
useholds was locaated in Los Angelles County (3,234
4,680).2 The
distribution of th
he number of households across SPAs show thaat the San Fernaando (SPA 2) area ranks highestt with the most number of
households at 21
1.7%, followed byy San Gabriel (SP
PA 3) at 17.4% an
nd South Bay (SPA 8) at 15.9%. SPA 4, one of SVM
MCS service plan
nning areas,
also made up a laarge percentage (13.6%, 438,522) of households. Together, SPAs 4 and 6 representt 694,963 househ
holds or 21.5% of Los Angeles
County.
mber of Households by SPA, 2009
Figure 8. Num
Number off
Householdss
3,234,680
Percenttage of Los
Angele
es County
100%
S
Service
Planning Area
A
S Fernando (2)
San
702,175
21
1.7%
S Gabriel (3)
San
563,935
17
7.4%
M
Metro
(4)
438,522
13
3.6%
West (5)
W
296,203
9.2%
SSouth (6)
256,441
7.9%
East (7)
360,211
1.1%
11
515,512
15
5.9%
3,132,999
96
6.9%
C
Cumulative
HealthyCity.org, 200
09
29
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
3,234,680
Percentage of Los
Angeles County
100%
90004
23,817
0.74%
90005
16,478
0.51%
90006
20,088
0.62%
90007
13,122
0.41%
90008
13,493
0.42%
90010
940
0.03%
90011
22,898
0.71%
90016
16,785
0.52%
90017
8,858
0.27%
90018
15,931
0.49%
90019
24,782
0.77%
90020
18,442
0.57%
90026
25,034
0.77%
90027
23,119
0.71%
90028
15,320
0.47%
90029
14,306
0.44%
90031
10,817
0.33%
90037
15,545
0.48%
90044
25,589
0.79%
90046
29,388
0.91%
90057
16,608
0.51%
371,360
11.48%
Number of Households
Los Angeles County
Zip Codes
Cumulative
Source: HealthyCity.org (Nielsen Claritas, Inc), 2009
30
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
31
Figure 11. Percentage of Individuals Maarried, Never Maarried, Divorced or Widowed in SVMCs Primary Service Area, 200
09
Los Angeles County
50%
44.3%
40%
41.5%
35.1%
33.7%
30%
20%
10%
8..1%
6.2%
7.2%
7.7%
10.9%
5.3%
0%
dowed
Wid
Divorced
Never maarried
Num
mber of children
entering Foster Care
35
16
23
25
62
0
194
49
1054
10, 191
Zip Code
90017
90018
90019
90020
90026
90027
90028
Number of children
entering Foster Care
24
4
55
49
14
4
44
4
7
9
Zip Code
90029
90031
90037
90044
90046
90057
90020
Number of child
dren
entering Foster Care
17
26
108
275
3
19
14
32
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
In 2008, there was a total of 141,882 Department of Children and Family Services (DCFS) child abuse referrals in Los Angeles County. In SVMCs
primary service area there was a total of 19,651 DCFS child abuse allegation referrals. Most referrals were from zip codes 90044 (3,683), 90011
(2,301), and 90037 (2,094). Please see Figure 13 for detailed data by SVMCs primary service area zip codes.
Figure 13. Child Abuse Allegation Referrals in SVMCs Primary Service Area by Zip Code, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
Service Area
Los Angeles County
Referrals
829
355
1,157
597
912
40
2,301
19,651
141,882
Zip Code
90016
90017
90018
90019
90020
90026
90027
Referrals
921
550
966
974
327
1,100
227
Zip Code
90028
90029
90031
90037
90044
90046
90057
Referrals
238
477
806
2,094
3,683
146
951
Within the same year, 1,084 children within SVMCs primary service area were removed from the home as a result of DCFS child abuse allegation
referrals. Most DCFS removals were from zip codes 90044 (286), 90011 (160), and 90037 (119). Figure 14 has detailed data by SVMCs primary
service area zip codes.
Figure 14. DCFS Removals in SVMCs Primary Service Area by Zip Code, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
Service Area
Los Angeles County
Removals
34
13
42
32
54
1
160
1,084
N/A
Zip Code
90016
90017
90018
90019
90020
90026
90027
Removals
51
30
69
37
20
45
6
Zip Code
90028
90029
90031
90037
90044
90046
90057
Removals
5
15
24
119
286
3
38
33
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Overall, few interview participants discussed foster youth. However, those that did discussed placement of foster youth. More specifically,
foster youth who went to an emergency room without a placement ended up spending hours waiting in the ER.
2.10 Poverty Rate
In 2010, there were 2,226,818 families living in Los Angeles County, of which 12.4% (275,280) were living below the federal poverty level
(Nielsen Claritas, Inc., 2010). Compared to California (9.8%) and Los Angeles County (12.4%), SVMC service area had a larger percentage (23.0%)
of families living below the federal poverty level. The two SVMC primary service area zip codes that report the highest percentage of families
living below poverty are 90017, at 36.6% (2,016) and 90037, at 32.6% (3,833) of families living below poverty. However, more than half of the
primary service area zip codes are below Los Angeles County poverty rate (12.4%). Percentage data for families living at or above poverty are
detailed in Figure 16.
34
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 15. Percentage of Families Living Below the Federal Poverty Level in SVMCs Primary Service Area, 2010
35
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 16. Percentage of Families Living At or Above the Federal Poverty Level in SVMCs Primary Service Area, 2010
36
% Famiilies At/Above
N
275,280
%
12
2.4%
N
1,951,53
38
%
87.6%
44,340
37,517
48,304
8,859
47,682
32,617
43,974
9.1%
9.0%
9.7%
19
6.2%
24
4.7%
1.2%
11
12
2.7%
442,147
7
4
377,824
196,423
3
133,228
8
145,397
7
258,203
3
301,591
1
90.9%
91.0%
80.3%
93.8%
75.3%
88.8%
87.3%
37
Figure 18. Mediaan Household Income in SVMCs Primary Service Area, 2009
Los Angeles County
$55
5,499.00
$48,587.00
$40,571.00
$22,152.00
$17,861.00
0
10000
20
0000
30000
40000
50000
60000
38
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 19. Percentage Employment Status in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles County
Civilian, Employed
N
%
29007
53.3%
17674
49.6%
24162
48.7%
16675
44.5%
12396
50.3%
906
49.9%
35509
44.8%
18051
48.7%
9914
48.4%
17365
45.9%
28949
52.6%
19915
53.9%
30339
52.5%
24121
55.1%
14004
53.0%
16330
47.6%
13897
46.4%
18268
42.9%
28222
43.7%
30042
63.3%
18558
49.3%
422,304
49.7%
4,278,222
55.4%
Civilian, Unemployed
N
%
3344
6.2%
2161
6.1%
3577
7.2%
2705
7.2%
1670
6.8%
62
3.4%
5061
6.8%
2293
6.2%
1218
5.6%
2913
7.7%
3449
6.3%
2014
5.6%
4118
7.1%
2211
5.0%
1985
7.5%
2070
6.0%
1601
5.4%
3739
8.8%
4909
7.6%
2221
4.7%
2438
6.5%
55759
6.6%
387,741
5.0%
SPA data reveal that those SPAs within SVMCs primary service area have a somewhat higher percentage of unemployment than Los Angeles
County, SPA 4 with 5.3% and SPA 6 with 6.6%, compared to Los Angeles County (4.4%). As would be expected, the rates for employed
individuals are lower compared to Los Angeles County. Also, the rates for individuals not in the labor force were also higher (SPA 4 with 37.5 %
and SPA 6 with 42.8%), compared to Los Angeles County (34.9%). Please see Figure 20 for more data.
39
Civiliaan Employed
Civilian Unemployed
U
Not in Labo
or Force
500
0.03%
1,063,293
64.3%
64,711
3.9%
524,733
31.7%
S Gabriel (3)
San
427
0.03%
880,001
61.4%
52,515
3.7%
500,872
34.9%
M
Metro
(4)
218
0.02%
546,127
57.2%
50,828
5.3%
357,648
37.5%
W (5)
West
177
0.03%
379,538
67.8%
19,696
3.5%
160,663
28.7%
S
South
(6)
185
0.03%
351,541
50.5%
46,064
6.6%
297,855
42.8%
E (7)
East
507
0.05%
578,650
58.7%
41,079
4.2%
365,976
37.1%
S
South
Bay (8)
912
0.08%
718,150
61.8%
50,464
4.3%
392,717
33.8%
4,273
3
0.05%
4,720,096
60.7%
342,835
4.4%
2,715,069
34.9%
L Angeles Countyy
Los
Source: Nielsen Claritass, 2010
3. Natality
3.1 Prenatal Care
e
The Healthy People 2010 objective is that at least 90% of motheers receive prenaatal care in the first trimester. From 2005 to200
06, 87.3% of
pregnant women
n in Los Angeles County began preenatal care in thee first trimester. However, a slighttly smaller percentage of uninsured pregnant
women (85.8%) are Hispanic/Latin
na and born in th
he United States (83.9%), living below the federal poverty level (83.6%), or are Medii Cal insured
(83.5%) began prrenatal care in their first trimester. An even smalller percentage off pregnant womeen who completeed some high school (79.8%),
were between th
he age of 15 and 19 (78.2%), or livving at home in which an Asian lan
nguage is primarily spoken (75.5%
%) began prenataal care in the
first trimester.
40
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
San Gabriel
(3)
Metro (4)
West (5)
South (6)
East (7)
South Bay
(8)
1.2%
1.3%
1.2%
1.2%
1.5%
1.2%
1.4%
6.2%
5.9%
5.6%
6.4%
6.4%
5.5%
6.3%
7.4%
7.2%
6.8%
7.6%
7.9%
6.8%
7.7%
Overall, in 2008 African Americans in Los Angeles County had the highest percentage of live births weighing below 5.5 pounds (13.5%).
Hispanics/Latinos and Pacific Islanders had the lowest percentage of live births weighing less than 5.5 pounds (6.4% and 6.5, respectively).
Figure 22. Percentage of Live Births that are Very Low and Moderately Low Birth Weight in each Racial/Ethnic Group, LA County, 2007 2008
Very Low Birth Weight (<3.25 pounds)
Los Angeles County
African American
American Indian/Alaskan Native
Asian
Hispanic/Latino
Pacific Islander
White
2007
Percentage
1.3%
2.9%
1.6%
1.1%
1.2%
1.0%
1.3%
2008
Percentage
1.2%
3.0%
1.8%
0.9%
1.1%
1.0%
1.2%
41
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2007
2008
6.1%
6.1%
African American
American Indian/Alaskan Native
Asian
Hispanic/Latino
Pacific Islander
White
9.8%
10.5%
6.8%
5.4%
4.1%
6.4%
10.5%
7.1%
6.9%
5.3%
5.4%
6.6%
7.4%
7.3%
African American
American Indian/Alaskan Native
Asian
Hispanic/Latino
Pacific Islander
White
12.7%
12.0%
7.9%
6.6%
5.1%
7.6%
13.5%
8.8%
7.8%
6.4%
6.5%
7.8%
42
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
No. of Births
971
600
1,037
530
457
16
2,702
770
456
853
1,025
17,394
139,679
Zip Code
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
No. of Births
625
983
432
241
565
643
1,412
1,942
321
813
43
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 24. Percentage of Births by Mothers Race/Ethnicity in SVMCs Primary Service Area, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles County
African
American/Black
2.0%
2.5%
1.9%
13.2%
55.1%
0.0%
6.6%
27.7%
4.6%
21.6%
12.9%
2.9%
3.9%
2.6%
5.0%
2.7%
0.2%
14.5%
29.8%
3.1%
2.7%
11.6%
7.4%
Asian
20.2%
24.3%
9.5%
4.7%
1.8%
68.8%
0.2%
1.3%
5.3%
1.6%
13.1%
46.1%
8.9%
18.1%
8.7%
9.4%
18.0%
0.3%
0.2%
11.2%
13.8%
8.5%
11.1%
Hispanic/Latina
65.2%
68.5%
85.6%
78.1%
38.3%
6.3%
92.5%
64.8%
86.2%
72.3%
61.5%
44.5%
70.2%
30.3%
56.0%
77.4%
76.5%
83.5%
68.3%
10.0%
80.9%
72.0%
63.1%
Native American
or Alaskan
Native
0.0%
0.0%
0.0%
0.0%
0.2%
0.0%
0.0%
0.1%
0.0%
0.0%
0.0%
0.2%
0.0%
0.0%
0.4%
0.0%
0.3%
0.0%
0.2%
0.3%
0.0%
0.1%
0.1%
White
11.0%
3.3%
1.6%
1.5%
1.8%
18.8%
0.3%
3.8%
2.2%
2.7%
10.5%
4.8%
14.5%
46.3%
26.6%
8.9%
4.0%
0.6%
0.5%
72.6%
1.9%
6.4%
16.1%
Two or More
Races
1.2%
0.8%
0.3%
0.9%
1.5%
6.3%
0.2%
1.8%
0.9%
1.6%
1.4%
0.6%
1.6%
1.4%
0.8%
0.9%
0.2%
0.4%
0.7%
1.6%
0.5%
0.9%
1.4%
Other Race
0.4%
0.5%
1.0%
1.5%
1.3%
0.0%
0.3%
0.5%
0.9%
0.1%
0.7%
1.0%
1.0%
1.4%
2.5%
0.9%
0.8%
0.7%
0.3%
1.3%
0.3%
0.7%
0.8%
In 2008 Hispanic women experienced births at a higher rate in SPA 4 (67.5%) and SPA 6 (77.8%), than in Los Angeles County (63.0%). African
American mothers gave birth at a higher rate in SPA 6 (19.2%) than in Los Angeles County (7.5%). In Spa 4, Asian (10.3%) and Filipino (3.1%)
mothers gave birth at a higher rate than in Los Angeles County (8.3% and 2.5%, respectively). Please see Figure 25 for more data.
44
African
American/B
Black
2.7%
2.7%
3.0%
4.9%
19.2%
2.3%
14.3%
7.5%
Asian
6.0%
20.1%
10.3%
14.0%
0.42%
3.7%
8.5%
8.3%
Filipino
3.6%
2.6%
3.1%
1.5%
0.2%
2.1%
3.4%
2.5%
Hispanic
56
6.4%
60
0.3%
67
7.5%
20
0.4%
77
7.8%
83
3.0%
54
4.1%
63
3.0%
Native Am
merican/
Alaskan
n Native
0.11%
0.14
4%
0.07
7%
0.01%
0.02
2%
0.16
6%
0.12%
0.12%
Hawaiiian/Pacific
Islander
0
0.16%
0
0.14%
0
0.07%
0
0.23%
0
0.18%
0
0.24%
1
1.17%
0
0.32%
White
28
8.7%
12
2.1%
14
4.0%
53
3.1%
1..0%
7..4%
15
5.5%
16
6.2%
Two orr
More Racces
1.3%
1.4%
1.1%
3.2%
0.7%
0.8%
2.2%
1.4%
Other
Race
1.1%
0.60%
0.97%
2.78%
0.44%
0.30%
0.79%
0.80%
Births by Age. Th
he percentage of births to motherrs age 20 or youn
nger (11.9%) is hiigher in SVMCs primary service area than that of Los Angeles
County (9.5%). More specifically, zip codes 90044 (16.5%), 90011 (1
16.0%), 90037 (14
4.7%), 90007 (13
3.4%), 90057 (13.0
0%), 90017 & 900
018 (both at
12.5%), 90006 (1
11.8%), 90008 (1
11.4%), 90026 (11.1%), 90031 (10
0.9%), 90029 (10
0.3%) and 90016
6 (9.9%) have higgher percentagess birthed by
younger motherss than Los Angelees County. Addittionally, the perccentage of births to mothers 20 to
o 29 years of agee is slightly higheer in SVMCs
primary service area (50.6%) than
n that of Los Anggeles County (48.8%). Just over half of zip codes in SVMCs primaary service area have higher
percentages of mothers 20 to 29 years of age than
n Los Angeles Cou
unty (48.8%). Pleease see Figure 26 for more data.
45
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 26. Birth by Mothers Age in SVMCs Primary Service Area, 2008
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles
County
Mother less
than 20 years
old
7.4%
7.8%
11.8%
13.4%
11.4%
0.0%
16.0%
9.9%
12.5%
12.5%
9.5%
5.9%
11.1%
2.8%
8.7%
10.3%
10.9%
14.7%
16.5%
1.6%
13.0%
11.9%
9.5%
Mother 20 29
years old
43.6%
47.0%
50.8%
51.3%
52.5%
56.3%
55.4%
54.0%
52.2%
55.3%
45.1%
43.4%
46.0%
34.7%
44.0%
51.9%
48.1%
55.3%
57.2%
24.0%
51.9%
50.6%
48.8%
Mother 30 34
24.6%
26.8%
21.8%
20.4%
19.9%
37.5%
17.6%
20.7%
22.4%
17.5%
26.4%
31.8%
22.8%
27.3%
24.1%
21.4%
23.8%
19.3%
15.0%
29.0%
21.9%
21.2%
24.0%
Mother 35
years and
older
24.4%
18.3%
15.6%
14.9%
16.2%
6.3%
11.0%
15.5%
12.9%
14.7%
19.0%
18.9%
20.1%
35.2%
23.2%
16.5%
17.3%
10.7%
11.3%
45.5%
13.2%
16.2%
17.6%
In SPA 6, the percentage of mothers less than 20 years of age and mothers between 20 and 29 years of age (14.8% and 55.2%) was higher than
in Los Angeles County (9.7% and 47.0%, respectively). In SPA 4, mothers between 30 and 34 years of age and mothers 35 years of age of older
had higher percentages (24.8% and 20.8%) than in Los Angeles County (24.2% and 19.0%, respectively).
46
Figure 27. Birtth by Mothers Age in SVMCs Primary Service Area, 2008
Area
San Fernando SP
PA (2)
San Gabriel SPA (3)
Metro SPA(4)
West SPA (5)
South SPA (6)
East SPA (7)
South Bay SPA (8)
Los Angeles Cou
unty
Motherr 20 29
yearss old
44.8%
44.6%
45.1%
25.3
37%
55.2%
51.1
17%
46.6%
47.0
0%
Mother 30 34
26.9
9%
26.4
4%
24.8
8%
34.6
6%
17.9
9%
22.6
6%
24.0
0%
24.2
2%
Mother 35 years
and older
21.0%
20.4%
20.8%
37.9%
12.2%
15.1%
19.7%
19.0%
4. Mortality
4.1 Deaths
In 2008 there we
ere a total of 58,,028 deaths repo
orted in Los Angeeles County. Of those reported deaths, 5,569 (9.6%) occurred witthin SVMCs
primary service area (California Deepartment of Pub
blic Health, 2008). Across SVMCss primary service area the averagee number of deatths was 265,
however a signifiicant number of the deaths were reported within service zip code 90044 (%, 533), 90019 (%, 428), and 90018 (%, 413) (CDPH).
Please see Figure
e 29 for more data.
47
413
265
Average
In SPA 4, there were 6,121 deatths which accounted for 10.5% of the total num
mber of deaths in
n Los Angeles County. There were a smaller
number of death
hs in SPA 6 (5,397
7), which accountted for 9.3% of deaths in Los Angeeles County.
Figure 29. Totaal Number of Deaaths by SPA, 2008
Los Ange
eles County
Deaths
58,028
Percentage of Los
L Angeles Countyy
100%
11,811
0.4%
20
10,563
8.2%
18
Metro (4
4)
6,121
0.5%
10
West (5)
4,156
7.2%
South (6))
5,397
9.3%
East (7)
7,066
2.2%
12
8,953
5.4%
15
48
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
gender vary greatly. In zip code 90010, there were a larger percentage of deaths among females (66.7%, 10) and in zip code 90017 there were a
larger percentage of deaths among males (61.8%, 47).
Deaths by Age. Deaths reported by age were significantly higher among adults, age 85 and above (26.5%, 1,475) and those age 75 to 84 (22.9%,
1,275) in SVMCs primary service area (CDPH). Those percentages were slightly lower than Los Angeles County (30.5% and 25.8%, respectively).
However, those less than one year old experienced a higher number of deaths (97) than those 1 to 4 years of age (15) and those 5 to 14 years of
age (26).
Figure 30. Deaths by Age Group in SVMCs Primary Service Area, 2008
Age 85 and over
1,475
Age 75 to 84
1,275
Age 65 to 74
829
Age 55 to 64
786
Age 45 to 54
553
Age 35 to 44
248
Age 25 to 34
149
Age 15 to 24
116
97
26
15
Note: The number of deaths are for the SVMC primary service area.
Source: California Department of Public Health (CDPH), 2008
Please note that the United States has one of the highest infant mortality rates of all developed countries. The leading causes of infant mortality
are birth defects, preterm birth/low birth weight, Sudden Infant Death Syndrome, maternal complications during pregnancy, and complications
affecting newborns due to the placenta, cord or membrane. Since 1980, California has had lower infant mortality rates than the rest of the
nation. For 2003 and 2004 Californias rate was 5.2 per 1,000 live births. In 2007, it was 5.3 per 1,000 for Los Angeles County. Infant mortality
49
rates among African Americans (10.7 per 1,000) were more than twice as high co
ompared to otheer ethnicities. SP
PAs 2, 3, 6, and 8 either had
equivalent or higher rates than Lo
os Angeles Countyy as a whole.
4.2 Cause of Deatth
The top two causses of death repo
orted for SVMCs primary service area were heart disease (28.9%, 1,609) and canceer (22.1%, 1,231)) (CDPH). In
the 2007 commu
unity needs assesssment, heart dissease and cancer were also the most common caauses of death. Other causes acccounted for
17.7% (988) of de
eaths, followed by strokes (6.5%, 363), diabetes (3
3.9%, 218), influeenza and pneumo
onia (3.9%, 216) unintentional injjuries (3.9%,
215), and chronicc lower respiratorry disease (3.8%, 212). Please see Figure 31 for mo
ore data.
1,609
Malignant Neo
oplasms (Cancer)
1,231
988
363
Diabetes Mellitus
218
216
Unintentional Injuries
215
212
Alzh
heimer's Disease
133
115
Chron
nic Liver Disease
112
80
77
Source: California Departmentt of Public Health (CDPH
H), 2008
50
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Metro
SPA 4
Coronary heart
disease
Homicide
West
SPA 5
Coronary heart
disease
Drug overdose
Drug overdose
Suicide
Lung cancer
Lung cancer
Homicide
Suicide
HIV
Motor vehicle
crash
Lung cancer
Motor vehicle
crash
Rank
1
2
South
SPA 6
Homicide
Coronary heart
disease
Motor vehicle
crash
Stroke
Diabetes
East
SPA 7
Coronary heart
disease
Homicide
South Bay
SPA 8
Coronary heart
disease
Homicide
LA County
Coronary heart
disease
Homicide
Motor vehicle
crash
Liver disease
Motor vehicle
crash
Lung cancer
Motor vehicle
crash
Drug overdose
Stroke
Drug overdose
Liver disease
Source: 2007 Los Angeles County Public Health: Mortality in Los Angeles County
3
4
County of Los Angeles Department of Public Health, Life Expectancy in Los Angeles County: How long do we live and why? A Cities and Communities Health Report
Los Angeles County Public Health: Mortality in Los Angeles County
51
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
B.
ACCESS
1. Health Insurance
Despite the passage of health care reform legislation, many components of which have not taken effect, many focus group and interview
participants reported seeing more and more people losing health insurance. Some of this has to do with high unemployment rate, as many
people have lost their insurance coverage when they were laid off. Health insurance is a particular problem for immigrants who are
undocumented, who would not quality for public insurance programs, or who are small business owners. For instance, a high percentage of
Koreans are uninsured. One participant explained, Many are undocumented, but we also have a large small business population. They make
too much money to get government benefits like Medi Cal, but they cannot afford their own insurance. They fall into that limbo area. Another
participant reported seeing many blended families, where the children are eligible for public programs but the adults remain uninsured. She
added, We find that adults put off services for themselves. Theyre afraid they would go in and get charged for services they cant afford.
1.1 Type and Status
In 2009, the Medi Cal beneficiary rate for Los Angeles County was 232.8 per 1,000 people (up from 228.1 in 2008), higher than of California
(188.0 per 1,000 people) (Healthy City). In 2008, the Healthy Kids enrollment rate for Los Angeles County was reported at 12.5 per 1,000
children, and in 2010, there were 522,363 WIC participants in Los Angeles County. However, in 2007 19.2% of adults 18 and over in Los Angeles
County did not have a regular source of care and 11.8% could not afford to see a doctor.
According to the California Health Interview Survey (CHIS), between 2003 and 2005, all but 3 of the 21 zip codes in SVMCs primary service area
had an uninsured rate above 20% of more among population ages 0 to 64. The zip codes with the highest rates of uninsured were 90017
(33.7%), 90006 (30.5%), 90057 (30.2%), 90005 (29.1%), 90029 (28.3%), 90011 (28.0%), 90031 27.5%), 90004 (26.8%), 90007 (26.8%), 90026
(26.6%), and 90037 (25.5%). In zip code 90017, about 1 in 3 people were uninsured. Please see Figure 33 for more details.
52
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 33. Percentage of Population without Health Insurance Coverage in SVMCs Primary Service Area, 2007
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
Zip Code
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
53
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Percent
80.8%
2007
Estimated #
5,998,000
2005
Percent
80.2%
2002 03
Percent
81.4%
1999 00
Percent
81.6%
82.7%
81.0%
74.1%
81.3%
79.1%
80.6%
83.5%
1,305,000
1,112,000
692,000
426,000
536,000
764,000
964,000
80.1%
84.4%
72.0%
84.8%
73.1%
80.9%
83.0%
82.0%
81.7%
73.9%
82.8%
79.6%
81.8%
85.0%
82.9%
83.8%
75.7%
83.1%
75.0%
81.4%
84.0%
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and
Epidemiology, LA County Department of Public Health
Focus group and interview participants discussed the decreasing availability of medical care and services as a result of the recession and budget
cuts. Some communities experienced hospital closure in their areas, and community organizations went bankrupt. Speaking specifically about
South Los Angeles, one participant noted that many private doctors who used to get referrals from hospitals that have since closed (including
MLK) had to relocate because they lost business without referrals. Also, because of the low Medi Cal reimbursement rate, many providers
refuse or have stopped taking patients with Medi Cal coverage. For this reason, participants emphasized that just because someone is insured,
it does not mean he or she has a regular source of care.
Focus group and interview participants stated that they continued to see people delaying medical care until their conditions or symptoms
became intolerable. One participant said that the only time some of their clients would go to the hospital is when the ambulance is ready to
pick them up, when theyre really, really sick. Emergency room continues to be the last resort for many community members who are
54
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
uninsured or who delay care. Having patients in ER whose symptoms do not warrant emergency care taxes the quality and efficiency of our
health care system.
2.1 DHS Use in the Past Year
Note: Data in this section has not been updated since the 2007 community needs assessment.
Although the rate of having a regular source of care has remained constant for Los Angeles County, the rate of receiving medical services from
Los Angeles County Health Department facilities has almost doubled from 1997 to 2005.
Figure 35. Percentage of Adults (18+ years) Reported Receiving Medical Services
from LA County Health Department Facilities in the Past Year by SPA, 2005
2005
Percentage
17.4%
15.4%
15.7%
22.7%
8.8%
27.1%
17.6%
14.9%
Estimated #
1,248,000
1999 00
Percentage
11.4%
1997
Percentage
9.9%
235,000
206,000
206,000
45,000
176,000
164,000
167,000
9.8%
11.4%
14.8%
8.2%
17.2%
10.3%
10.7%
8.5%
8.6%
12.0%
9.3%
15.6%
9.1%
9.2%
Source: 2005, 1999 00 & 1997 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services
3. Specialty Care
In response to specialty access problems, community clinics and health centers have begun to slowly increase their specialty services to meet
the growing needs of their patients by developing productive and ongoing relationships with local, private specialists who are willing to accept
patients on a paid or pro bono basis and share specialty services amongst other clinics and health centers (California Health Care Foundation,
2009).
In fact, according to the 2007 Specialty Care Access Survey (2009), 61% of responding community clinics and health centers provided some
specialty services onsite, and more than a third of those offered three or more specialties. Because of the increase in on site specialty care,
55
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
clinics and health centers report more frequent and faster service provider delivery for patients with urgent needs and more frequent and faster
receipt of consultation reports compared to patients who were referred out for specialty care.
Overall, community clinics and health care centers need to provide a minimum level of data to identify continuing access gaps, ensure the
efficient use of resources and the fiscal health of the community clinics and health centers, and demonstrate improvements in access, or lack
thereof (2009). The Pacific Health Consulting Group advises providers to measure, monitor, and report on the following 12 items for internal
services and for services provided to specialty network partners (California Health Care Foundation, 2009).
Figure 36. Twelve Program Indicators to Measure, Monitor and Report
Wait times for specialty services, by type of service and by provider
No show rates, by type of service and provider
Percentage of visits in which patients arrive with necessary ancillary
services complete and results available for the specialists
Provider retention rate by specialty
Specialists reported satisfaction with clinic systems and staff support
Ratio of regular support staff to specialist
Focus group and interview participants stated that specialty care is particularly lacking in their community. Dental care was often cited to be one
of the areas that is most in need since Denti Cal has been cut for adults recently. One participant estimated that about three times more people
dont have dental insurance than health insurance. He cited a recent study conducted by a colleague that showed a correlation between cuts of
Denti Cal and increase in emergency room visits attributed to different dental coding, which has more than doubled. He added that even
though children still have access to Denti Cal, there has always been a lack of dental providers for children. Another participant added that most
clinics do not offer dental care, even though a lot of primary care providers realize their clients need a more holistic provision of health care that
includes dental, vision, and mental health. One participant remarked that, as a last resort, people rely on word of mouth to find unlicensed
dentists in private homes or even garages: They call it garage dentistry or swap meet dentistry.
The hardship caused by economic downturn also exacerbates existing illnesses, as participants began to see more patients with multiple
diagnoses and symptoms that give rise to the need for specialists like neurologists and gastroenterologists. One participant said, When I was a
resident many years ago, subspecialty patients were 10 12%. Now theyre closer to 50%, representing 21 different subspecialties.
There is also disparity in access to specialty care, as it is particularly lacking in medically underserved areas. For instance, one participant stated
that there was no cardiologist in the South Los Angeles area, even though South L.A. has the worst CHD [coronary heart disease] rate in the
56
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
County. The lack of specialty care in some communities is one reason why some participants were concerned about the health care reform
legislation that was passed in 2010. One explained, We feel that managed care right now has to show they have the doctors in place before
you move a huge chunk of new enrollees into the program, especially given our history in South L.A. If you dont have the specialists there, that
causes a lot of havoc on a persons continuity of care.
3.1 Special Health Care Needs
In 2008, 2.9% (274,930) of children under the age of 18 in California had major disabilities (serious difficulty in at least one of four basic areas of
functioning: vision, hearing, ambulation, and cognition)5. Of those children, 2.8% (71,783) were in Los Angeles County. In 2010, there were a
total of 680,164 children in California enrolled in special education due special health care needs (SHCN)6. Of those children, 26.8% (182,597)
were in Los Angeles County.
In 2010, a large percentage of children enrolled in special education in schools was Hispanic/Latino (48.3% in California and 61.3% in Los Angeles
County). A larger percentage of African American children in Los Angeles County (14.0%) are enrolled in special education than in California
overall (11.1%). However, a smaller percentage of Caucasian children in Los Angeles County are enrolled (18.9%) than in California (33.0%).
Figure 37. Percentage of Children Enrolled in Special Education, 2008
Ethnicity
African American/Black
Asian American
Caucasian/White
Filipino
Hispanic/Latino
Native American or Alaskan Native
Pacific Islander
California
11.1%
4.6%
33.0%
1.6%
48.3%
0.9%
0.5%
Los Angeles
County
14.0%
3.8%
18.9%
1.3%
61.3%
0.4%
0.3%
Source: Special Tabulation by the State of California, Department of Education, Special Education
Division; Assessment, Evaluation and Support.
57
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 39. Percentage of Hospital Diversion to 911 Traffic Due to Emergency Department Saturation by SPA, 2010
2010
Percentage
10.1%
2009
Percentage
10.8%
2008
Percentage
13.2%
10.0%
7.0%
16.0%
9.0%
11.0%
9.0%
14.0%
9.0%
15.0%
14.0%
12.0%
12.0%
58
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
South (6)
East (7)
2010
Percentage
8.5%
12.0%
2009
Percentage
10.2%
11.0%
2008
Percentage
10.9%
14.0%
59
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 41. Los Angeles County EMS Agency Pediatric Trauma Hospital Volume, 2006
Pediatric
Cases
Los Angeles County, by Year
2000
2,063
2001
2,245
2002
2,156
2003
2,001
2004
1,891
2005
1,675
2006
1,787
% Pediatric
Cases
Total Number
of Cases
12.2%
11.9%
11.2%
11.0%
11.0%
9.5%
9.6%
16,912
18,837
19,196
18,150
17,134
17,680
18,632
5. Barriers to Access
5.1 Difficulty in Accessing Care
In 2007, 27.3% of adult residents over 18 years of age in Los Angeles County reported that obtaining medical care across the County when
needed was either somewhat or very difficult. SPAs 4 and 6 had the highest percentage of residents (33.3% and 38.8%) who reported that
obtaining medical care when needed was either somewhat or very difficult. However, those percentages have decreased since 2005 for both
SPAs (37.8% and 43.9%).
Figure 42. Percentage of Adults (18+ years) Who Reported That Obtaining Medical Care Is Somewhat or Very Difficult by SPA, 2007
2007
Percentage
Estimated #
27.3%
1,965,000
21.8%
30.6%
33.3%
13.8%
38.8%
27.2%
25.7%
336,000
398,000
297,000
69,000
256,000
252,000
288,000
2005
Percentage
30.1%
2002 03
Percentage
27.9%
1999 00
Percentage
27.0%
29.1%
23.9%
37.8%
19.1%
43.9%
34.2%
26.2%
25.5%
27.0%
34.9%
18.9%
36.2%
28.7%
26.0%
25.8%
23.9%
31.7%
24.8%
39.7%
28.1%
23.0%
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
60
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Focus group and interview participants cited various barriers when accessing medical care. One key barrier to access is the lack of knowledge in
navigating through an extremely complicated health care system. Participants shared that some patients would turn away from services
because of long waiting time or cumbersome paperwork that asks for a lot of sensitive information (especially for those who dont speak or
write English proficiently). One participant also said that patients often disengage from services because they were given appointments 5 or 6
months from the time they are requested. Participants also believed that some providers, even if they were very good at providing treatment
services, lack the customer service skills necessary to build trust with the patients. One participant believed that patients are often given the
run around that they are unable or unprepared to move through the complicated bureaucracy. Some participants lamented that there are not
enough advocates who could help community members handle the bureaucracy and advocated more support for case management.
Another related challenge is the fluctuations in funding. Some programs come in and out of the community based on availability of funding.
Also, patients who were formerly eligible for a program may find themselves ineligible if there is a change in funding regulations. This makes it
harder to navigate an already very complicated system. Many community members who fail to access services will become disillusioned and
diminish any chances of future attempts at access. One participant said confidently that most of the barriers can be eliminated if social workers
are in place to coordinate care, especially when you have a population with high needs and limited resources. Case managers can be the ones
that bring different professionals together.
Participants also cautioned against equating having insurance with having access to care. One remarked, Insurance is not the end all in terms
of access. Cost is still an issue for those who are insured. Many providers do not take clients with Medi Cal because of its low reimbursement
rates. In many medically underserved areas, one participant said, even if you do have an insurance card, it doesnt mean youll get to see a
doctor or get your medical problem fixed, or even get an appointment, just because you dont have enough facilities and clinics in the area. For
this reason, many participants were concerned about the impact of the recent health care reform legislation and stated that these communities
need to increase their capacity so that they could meet the demands of the increase in the insured population.
Another challenge that deters the community from access services are limited or inflexible hours of operation. Especially for many patients who
toil in service and manufacturing industries (such as hotel, restaurant, and garment industries) as well as small business owners, it is not realistic
to wait hours at a time for medical services without some consequences to their employment or finances. One participant acknowledged that
some clinics and hospitals had extended their hours during the week, but she added, Expanded hours are great, but 24 hours are even better.
Another participant believed that for many working immigrants, weekend hours are preferable to any time during the work week.
Two participants who have served their respective community for more than 20 years cited that accessibility improved for a while but only to
have worsened in the last few years. The outcomes of having accessible and adequate services were apparent to one of the participants. She
attributed the reduction of breast and cervical cancer incidences in the Thai community she serves to many years of prevention services that are
no longer available. She also credited the development of the Asian Pacific Health Care Venture in the late 1990s as a lifesaver to that
community, which has many Thai speaking staff. However, she conceded that with budget cuts, even that clinic had to refer out a lot to other
61
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
providers who do not have the language capacity. Similarly, the other participant said that she was afraid things were going back to what it was
15 20 years ago because of the budget cuts.
However, both providers and patients from focus groups and interviews cited that access to care is not a problem when someone is aware of
local, low cost, culturally and linguistically competent services at clinics, community health centers, and nonprofit organizations. Participants
who were providers cited that they have developed trusting relationships based on many years of serving their communities as a reason why
community members would seek out and accept services from them, including prevention services.
5.2 5.6 Could Not Afford to See a Medical Doctor, Mental Health Care, Dental Care, Eyeglasses, or Medication (Rx)
In the 2007 community needs assessment, based on 2005 numbers, it was reported that competing priorities for financial resources are more
common among low income and uninsured, and require people to make difficult decisions in terms of prioritizing their basic needs, often
overlooking medical needs (Diamant, 2005).
In 2007, 11.8% of adult residents over 18 years of age in Los Angeles County were unable to see a medical doctor for a health problem in the
past year because they could not afford it. In SVMCs primary service area, SPAs 4 and 6 had the highest percentage of residents (16.1% and
18.6%) unable to see a medical doctor because they could not afford it. However, those percentages have decreased since 2005 for both SPAs
(21.3% and 22.2%).
Figure 43. Percentage of Adults (18+ years) Unable to See a Doctor in the Past Year Because They Could Not Afford It by SPA, 2007
2007
Percentage
Estimated #
11.8%
879,000
10.4%
10.2%
16.1%
8.6%
18.6%
11.8%
10.3%
164,000
140,000
148,000
45,000
127,000
113,000
120,000
2005
Percentage
15.6%
2002 03
Percentage
13.2%
1999 00
Percentage
13.5%
1997
Percentage
18.0%
14.6%
12.2%
21.3%
12.6%
22.2%
14.5%
14.7%
11.8%
11.3%
19.1%
9.9%
16.4%
13.6%
12.1%
11.6%
12.6%
19.0%
12.2%
16.2%
13.1%
11.7%
16.2%
17.5%
23.2%
15.8%
22.7%
18.4%
15.7%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
In 2007, 5.9% of adult residents over 18 years of age in Los Angeles County were unable to obtain mental health care or counseling in the past
year because they could not afford it. In SVMCs primary service area, SPAs 4 and 6 have the highest percentage of residents who were unable
62
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
to obtain mental health services because they were unable to afford it (7.3% and 10.9%). However, those percentages have decreased since
2005 for both SPAs (9.1% and 12.0%).
Figure 44. Percentage of Adults (18+ years) Unable to Receive Mental Health Care or Counseling in the Past Year Because They Could Not
Afford It by SPA, 2007
2007
Percentage
Estimated #
5.9
441,000
5.5
5.6
7.3
3.5
10.9
4.4
5.9
87000
77000
68000
18000
74000
42000
68000
2005
Percentage
7.8
2002 03
Percentage
6.5
1999 00
Percentage
7.8
1997
Percentage
8.0
7.8
4.5
9.1
8.8
12.0
6.9
8.3
5.0
7.2
9.3
7.2
6.3
6.0
6.2
8.1
6.5
11.2
6.7
8.9
5.9
7.7
8.3
7.3
9.7
10.5
9.2
7.7
6.0
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
In 2007, 22.3% of adult residents over 18 years of age in Los Angeles County were unable to obtain dental care (including check ups) in the past
year because they could not afford it. In SVMCS primary service area in 2007, SPAs 4 and 6 have the highest percentage of residents (27.7% and
28.8%) who did not obtain dental care (including check ups) in the past year because they could not afford it. While those percentages have
decreased since 2005 for both SPAs (31.8% and 35.1%), they still remain the highest rates across the country.
Figure 45. Percentage of Adults (18+ years) Unable to Obtain Dental Care in the Past Year Because They Could Not Afford it by SPA, 2007
2007
Percentage
Estimated #
22.3%
1,655,000
20.4%
19.4%
27.7%
13.4%
28.8%
24.0%
22.1%
322,000
268,000
256,000
700,00
196,000
228,000
256,000
2005
Percentage
25.6%
2002 03
Percentage
23.5%
1999 00
Percentage
23.6%
1997
Percentage
26.5%
24.4%
20.0%
31.8%
20.3%
35.1%
26.7%
24.4%
21.2%
23.7%
29.1%
18.6%
27.0%
26.0%
21.0%
22.5%
21.4%
30.4%
21.1%
29.0%
23.6%
21.2%
25.7%
26.6%
30.5%
22.3%
32.6%
28.3%
21.4%
63
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
Percentage
14.3
Estimated #
1,041,000
2002 3
Percentage
13.3
1999 00
Percentage
12.5
1997
Percentage
15.4
13.4
12.0
15.7
8.8
22.0
13.9
15.0
207,000
159,000
144,000
47,000
145,000
130,000
170,000
10.1
13.4
18.3
10.1
14.5
14.9
12.9
12.1
10.7
14.7
11.4
16.3
13.3
10.9
15.3
15.5
16.5
13.2
17.5
15.5
14.8
Source: 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
The cost of prescription medications continues to be a problem for low income, uninsured and under insured individuals and families. Despite
the creation the California Discount Prescription Drug Program7 in 2006 aimed at alleviating the burden of medication cost for individuals and
families that are low income, many are still going without their medication.
In 2007, 12.1% of adult residents over 18 years of age in Los Angeles County did not get prescription medication in the past year because they
could not afford it. SPAs 4 and 6 have the highest percentage of residents (13.7% and 18.7%) who did not get prescription medication in the
past year because they could not afford it. However, in 2005 these percentages were even higher (17.7% and 25.0%).
In California In 2006, Assembly Bill 2911 created the California Discount Prescription Drug Program to alleviate the cost burden of medications low income individuals and
families. Specifically, the bill reduces prescription drug prices from 40 to 60% of the retail price for generic and brand name drugs for individuals in families with incomes below
300% of the federal poverty level (in 2006 07, $29,400 for an individual and $60,000 for a family of four), to individuals with unreimbursed medical expenses and incomes below
the state median family income (in 2006 07, $68,310 for a family of four), and to eligible seniors whose medications are not covered by Medicare. Taken from: Governors
Budget Summary 2010 2011 Office of Statewide Health Planning and Development. Accessed 11/02/2007 at
http://www.ebudget.ca.gov/pdf/BudgetSummary/HealthandHumanServices.pdf.
64
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 47. Percentage of Adults (18+ years) Who Did Not Get Prescription Medication in the Past Year Because They Could Not Afford It by
SPA, 2007
2007
2005
Percentage
12.1%
Estimated
#
901,000
Percentage
14.9%
9.7%
12.2%
13.7%
7.7%
18.7%
13.6%
10.9%
154,000
169,000
128,000
40,000
127,000
130,000
126,000
13.7%
11.8%
17.7%
8.1%
25.0%
15.4%
14.4%
2002 03
1999 00
1997
Percentage
13.2%
Percentage
12.6%
Percentage
15.9%
11.7%
12.1%
15.0%
10.2%
18.0%
15.2%
12.1%
10.6%
9.2%
18.1%
10.0%
15.6%
13.6%
12.2%
14.9%
15.6%
17.5%
14.2%
20.8%
17.3%
13.0%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
The cost of medical care is a barrier that many focus group and interviews participants mentioned. One participant remarked that low income
immigrants wont access any service if they think its too expensive. Another participant stated that if theres anything that catches people
attention in the Latino community, its signs that say free or low cost. For many, especially undocumented immigrants, there is a lack of or
limited access to public insurance programs. One participant said that people are afraid to go to the doctors because they might be charged.
Since they cannot access all the medical services they need in one place, i.e. no medical home, providers are seeing that the uninsured
population has to cobble together a patchwork of services, where they jump from place to place not because they want to, but because they
have to. A participant cited a diabetic patient who had to go to one clinic for his medication, and another clinic for a retinal scan, and yet
another for podiatry. Consequently, communication among providers is key to the management of his chronic disease.
Even for those who are eligible and have obtained coverage, cost can be a factor, as insurance might not cover all the expenses. One participant
who worked in the Latino community stated, Managing their diabetes even when theyre provided with a glucometer to check their sugar is a
challenge because the strips are very expensive and are not covered by many health insurances. Some immigrants who have Medi Cal may
hesitate to use services until the conditions become too severe because, as some participants stated, they erroneously believe that using these
services would jeopardize their chances of naturalization down the line.
Because of the high cost of mainstream medical care, many Asian and Latino immigrants turn to traditional or folk medicine, such as herbs, for
treatment. Sometimes the medicine is prescribed by a traditional healer; other times, immigrants self medicate. One participant remarked that
cost is why the black market medicine is becoming more popular lately in immigrant communities. People would go to these stores and tell the
65
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
store what they want, and it is in the back shelf or something. Sometimes you can find tetracycline and antibiotic. Some immigrants also visit
their home countries for care. Participants discussed some Latino immigrants who would go across the border to see a doctor or get
prescription drugs because of their availability and accessibility. Even Asian immigrants would travel out of the country to get more affordable
care. One participant shared that there are Korean tour groups that would take community members to get a full body check up or a CAT scan
or MRI in a hospital in South Korea in lieu of getting services in the U.S.
5.7 Transportation Barrier
County data from the Los Angeles County Health Survey indicate that transportation problems that have kept patients from obtaining needed
medical care in the past year are on the decline. In fact, for Los Angeles County current 2007 rates have fallen to 2002 03 percentage rates
(7.4%). In SVMCs primary service area, SPAs 4 and 6 had the highest rate of residents who reported transportation problems kept them from
obtaining medical care in the past year (9.7% and 12.5%). However, these percentages have decreased significantly for both SPAs since 2005
(11.9% and 18.1%).
Figure 48. Percentage of Adults (18+ years) Who Reported Transportation Problems Kept Them from Obtaining Medical Care in the Past Year
by SPA, 2007
2007
Percentage
Estimated #
7.4%
551,000
6.15%
7.2%
9.7%
3.2%
12.5%
6.9%
6.2%
96,000
10,000
91,000
17,000
85,000
66,000
71,000
2005
Percentage
9.5%
2002 03
Percentage
7.4%
7.1%
7.2%
11.9%
4.3%
18.1%
9.6%
10.3%
5.7%
6.4%
9.4%
3.9%
11.6%
8.8%
7.0%
Source: 2007, 2005 and 2002 03 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health
Many focus group and interview participants also identified transportation as a significant barrier to accessing services. Patients who rely on
buses are at the mercy of their schedule. One participant shared that some patients had missed their appointments because their bus was late.
It is not uncommon that people would travel more than an hour on public transportation to get to their appointments. Transportation is a
challenge for the elderly, many of whom do not drive or have trouble walking long distances. Transportation is also a barrier for families with
young children that is often correlated with childcare. Some participants cited examples of adults managing multiple children on a bus or
66
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
subway in order to make an appointment for themselves or for their children. However, many community members from a focus group, a
majority of whom rely on public transportation, stated that they would find ways to get to services if they find services they trust (i.e. culturally
and linguistically competent) and that are high quality.
5.8 Language Barrier
Closing the language and cultural gap is critical, as discordant language ability may lead to misunderstanding and inappropriate care (Diamant,
2005). In 2007, 15% of adult residents over 18 years of age in Los Angeles County who completed the Los Angeles Health Survey Interview in a
Non English Language reported difficulty talking to a doctor or health care professional because of a language barrier in the past year. As Figure
50 indicates, this is the lowest percentage since 1999. In SVMCs primary service area, SPAs 4 and 6 showed the highest percentages of residents
who reported difficulty talking to a doctor of health care professional because of a language barrier (20.4% and 18.7%). However, these
percentages have decreased for both SPAs since 2005 (22.9% and 24.9%).
Figure 49. Percentage of Adults (18+ years) Who Completed the Survey Interview in a Non English Language in the Past Year and Who Also
Reported Difficulty Talking to a Doctor or Health Care Professional Because of a Language Barrier by SPA, 2007
2007
Percentage
Estimated #
15.1%
319,000
13.3%
11.0%
20.4%
43,000
50,000
81,000
18.7%
14.5%
13.9%
51,000
50,000
34,000
2005
Percentage
18.7%
2002 03
Percentage
19.3%
1999 00
Percentage
16.2%
17.3%
16.0%
22.9%
27.1%
24.9%
15.9%
13.5%
21.3%
17.8%
19.1%
17.0%
14.0%
16.0%
18.3%
16.0%
14.0%
22.0%
21.0%
17.3%
21.8%
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
Focus group and interview participants identified the lack of linguistic competence as a barrier to accessing services. According to one
participant, the Korean community is over 70% immigrant and over 50% English speaking. Monolingual Korean speaking population is not
comfortable going outside of their comfort zone. Some participants also distinguished cultural competence from linguistic competence. One
participant remarked, Mainstream organizations make the mistake of thinking theyre going to hire a Korean speaker and now Koreans will
come to them. It was suggested that organizations need to go out and build these relationships with immigrant communities (through
collaborating with organizations that are already serving these communities), instead of hiring bilingual staff and waiting for the communities to
go to them. Another participant gave an example of cultural incompetence (and why language is not enough): We have a Latina diabetic
67
woman, and her provider is Spanish speaking but not Latino. The provider told heer not to eat tortillas because its white flour. And
d the doctor
couldnt Figure out why the womaan is non compliaant?
One participant remarked that, even though maany children of Asian immigrantss could speak En
nglish, many still found mainstream services
uninviting becausse there are still cultural issues. Another particip
pant explained, Language is a barrier also for children who begin to transition
from home langu
uage to English ass they enter the school system.
Undocumented im
mmigrants, particcularly in the Asiaan and Latino com
mmunities, have tremendous fearr of deportation because of their immigration
status. Participants believed thatt a provider cann
not build trust wiith these immigrants unless she or he can demon
nstrate cultural and linguistic
competence.
6. Senior Care
Californias adult population, 60 and older, continu
ues to significantly
increase in size an
nd need. From 1950 to 2000, thee proportion of
older adults incre
eased 194% (1.6M
M vs. 4.7M). This trend is expected
d
to continue at 128% from 2010 to
o 2050, when the number of adultts
60 and older will grow to 14.6M. In just over the next ten years, it is
projected that ad
dults 60 years and
d older will comprise nearly 20% of
Californias total population.
20.0
15.0
11.5
12.9
14.6
8.9
10.0
4.2
4.7
6.4
5.0
2.6 3..0
The California De
epartment of Agin
ng State Plan on Aging for 2009
1.6
6 2.0
2013 cites the inccreasing health and service needs for diverse groups
0.0
of older adults an
nd adults with dissabilities.8 Locallyy, for example,
195
50 1960 1970 198
80 1990 2000 20
010 2020 2030 20
040 2050
during 2007 and 2009, over half (5
53%), or an averaage of 574,000, of
Los Angeles Coun
ntys seniors 65 yeears and older were disabled due
A
to a physical, men
ntal, or emotionaal condition.9 Thiis is also
compounded with seniors worsen
ning health conditions. The Los Angeles County Heealth Survey of seenior health trends from 2005 to 2007
indicated that:
California Departme
ent of Aging, Californ
nia State Plan on Agin
ng, 2009 2013
The Regents of the University of Californ
nia, California Health
h Interview Survey (C
CHIS), 2011
68
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
In 2007, among those aged 60 64, 13.9% (67,000) and those aged 65 and over, 23.7% (246,000) had been diagnosed with heart disease.
Heart disease rates increased from 2005, where those aged 60 64, 13.3% (55,000) and those aged 65 and older, 22.1% (221,000) were
diagnosed with heart disease.
In 2007, among those aged 60 64, 52.3% (250,000) and those aged 65 and over, 51.6% (531,000) had been diagnosed with high
cholesterol. Two years earlier, cholesterol figures were lower by as much as 8% for seniors 60 64 and 4% for seniors over 65. In 2005,
44.3% (181,000) of seniors 60 64 and 47.9% (478,000) of seniors 65 and older were diagnosed with high cholesterol.
From 2005 to 2007, the overall percentage of seniors reporting poor health status declined by almost three percent (2.8%). However
when broken down by subgroup, a greater percentage of adults 60 64 self reported poor health and a smaller percentage of adults 65
and older self reported poor health from 2005 to 2007. In 2007, among those aged 60 64, 30.5% (147,000) indicated poor health status
and of those aged 65 and over, 29.5% (303,000) indicated poor health status. Compared to 2005, among those aged 60 64, 28.4%
(117,000) and those aged 65 and over, 32.2% (323,000) indicated poor health status.
Findings from the previous needs assessment cited that many needs for the majority of older adults and adults with disabilities in Los Angeles
County go unmet due to a lack of information regarding the availability of services and lack of information on how to access them (County of Los
Angeles Area Agency on Aging, 2005). Specifically, the Los Angeles Countys Area Agency on Aging 2005 2009 Plan found that a lack of service
coordination among an overly fragmented and often competitive long term care system contributes to this problem.10
During key informant focus group discussions in 2010, seniors were asked to talk about current health issues affecting their neighborhoods. In
general, seniors reported concerns about the down economy, coupled with rising health care costs and living expenses; limited dental and
specialty care; and insufficient access to cultural and linguistic services. The 2009 California Health Interview Survey (CHIS) data for Los Angeles
County reported that:
In 2009, 5.1% (55,000) of seniors aged 65 years and older delayed or did not seek medical care. Two years prior in 2007, during the
height of the economic downturn, 7.1% (74,000) of Los Angeles County seniors delayed medical care.
Additionally, the most available CHIS data reported that in 2003, 12.0% (1,032,000) of Los Angeles County seniors could not afford
needed dental care.
Seniors who participated in community focus groups, also shared that they are satisfied with several components of their senior care center and
view their center as a valuable resource that has positively impacted the health of the community. For instance, surveyed seniors enjoy the
centers diversity, great food, and reliable transportation.
10
County of Los Angeles Area Agency on Aging, 2007 08 Update, Draft: Pending Board Approval: Area Plan 2005 09 Future Focused Leadership: Building and Reinventing, June,
2007
69
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
In terms of staffing, seniors said they like the fact that staff are also reliable, caring, and very informative about senior health issues. As a matter
of fact, the nutritious food clients receive at their local senior center was a major reason why they attend because without the extra help from
the staff, seniors said they would experience problems in managing their diabetes and hypertension. Similar to community focus group findings,
CHIS data reported that:
In 2009, 94.0% (1,075,000) of Los Angeles County seniors over the age of 65 had a usual place to go for medical care or health advice.
Compared to 2005, the proportion of Los Angeles Countys seniors that had a usual place to go to when sick or for health advice was
higher at 97.4% (984,000).
Overall, to meet the health service needs in the community, seniors, as well as providers, expressed the need of hospitals to disseminate health
information, specifically, at local health care centers. Seniors also shared the need for hospitals to offer low cost, non emergency services to
limit expenses and non emergency use of emergency room services.
In 2009, nearly one in five (18.3%), or 197,000, seniors 65 years and older visited the emergency room in the past 12 months. This is
down 6.0% from 2007, where nearly one in four (24.1%), or 251,000, seniors required an emergency room visit (CHIS, 2011).
Specific to SVMCS primary service area:
In 2009, 4.0% (7,000) of seniors 65 and older delayed or did not get medical care while 6.4% (12,000) delayed care in 2007.
In 2009, 91.0% (185,000) of seniors over the age of 65 had a usual source care compared to 94.0% (174,000) in 2005.
2009 emergency room use levels for Los Angeles County were similar to SVMCs primary service area. In 2009, 19.0% (39,000) of seniors
used the emergency room while 22.0% (40,000) of seniors used the emergency room in 2007 (CHIS, 2011).
7. Community Clinics
Data from the previous needs assessment reported a total of 172 community clinic sites in Los Angeles County in 2003 that served 732,040
patients and conducted 2,197,121 service encounters (Office of Statewide Health Planning and Development, 2003). Since then, trend data
indicate a steady growth in the number of Los Angeles County clinics, patients, and encounters. Los Angeles County has seen its largest primary
clinic growth from 2003 to 2004, with an increase of 7.6% (13 clinics) in one year. Since then, the percentage of patients served has increased by
as much as 9.3% from 2005 to 2006.
70
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 51. Primary Care Clinic Demographic & Utilization Information, Los Angeles County, 2007
Year
2003
Clinics
172
Patients Served
732,040
Service Encounters
2004
185
772,254
2,438,716
2005
184
837,654
2,601,051
2006
200
915,521
2,903,254
2007
202
941,774
2,986,103
2,197,121
The number of selected procedures for health screenings, tests, and immunizations has been mixed. Mammogram screenings were previously
on a rise year over year from 2003 to 2006. However, mammogram screenings have dropped significantly in 2007. Pap smear trends were in
reverse. The number of pap smear procedures saw a decline early on from 2003 to 2004. Since 2005, the number of pap smear screenings is on
the rise. This pattern is also similar for HIV testing and vaccination procedures. Please see Figure 53 for detailed data of Los Angeles Countys
primary clinic medical procedures.
Figure 52. Primary Care Clinic Selected Procedural Information, Los Angeles County, 2007
Year
Mammogram
HIV Testing
Pap Smear
2003
23,768
33,718
114,691
Contraceptive
Management
40,713
2004
25,203
29,862
107,139
113,108
222,624
2005
40,472
30,903
119,643
78,184
274,468
2006
46,849
40,670
117,056
95,254
280,877
2007
28,391
57,377
125,774
92,151
325,078
Vaccinations
271,583
One of five patient visits to a Los Angeles County primary clinic was covered through the Countys Public Private Partnership (PPP) Program, for
an average cost of $569,792 a year. 11 The PPP Program was created in 1997 and is a joint effort between the Los Angeles County Department of
Health Services and private, community based providers, or partners. The goal of this partnership is to provide quality cultural and linguistic
primary, dental, and specialty care services to low income and uninsured individuals not covered by other government or third party programs.
Figure 53 lists the total number of PPP providers by SPA.
11
California Office of Statewide Health Planning and Development (OSHPD), 2003 2007
71
13
Metro (4)
38
West (5
5)
South (6)
(
20
East (7)
21
South Bay
B (8)
19
8. Disability
The 2008 Americcan Community Survey estimated that 2.9% (274,9
930) of Californiaans under the agge of 18 were dissabled and 8.2% (1,872, 819)
aged 18 to 64 we
ere disabled and
d 39% (1,544,874
4) of the population over 64 yearrs of age were diisabled. Children
n under 5 were identified as
having a disabilityy for the Americaan Community Su
urvey if they repo
orted having a hearing or vision diffficulty. Children
n 5 to 14 with heaaring, vision,
cognitive, ambulaatory, or self caree difficulties weree reported as disabled. Individuals aged 15 and ovver with the sam
me difficulties as those aged 5
12
72
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
to 14 or they had independent living limitations were classified as disabled.14 Nationally, Californias disability prevalence rate for adults 18 and
over was moderate compared to the rest of the country. Regionally, California is one of four western states with the lowest percentage of
disability occurrences, excluding Hawaii.15 State prevalence percentage rates by state are detailed in Figure 54 below.
Figure 54. Disability Percentage Prevalence by State, 2008
Source: Center for Disease Control and Prevention, Disability and Health, 2008
14
15
Kidsdata.org
Center for Disease Control and Prevention, Disability and Health, 2008
73
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
C.
Focus group and interview participants felt that preventative care and having healthier behaviors were difficult for certain populations for a
variety of reasons, although many understood the importance of a healthy lifestyle. One interview participant lamented, our healthcare system
is not set up to be preventive in nature. It is very reactionary and set up to reward taking care of problems that pop up instead of paying for
preventive and health promoting services. Other focus group and interview participants shared a similar concern that, due to budget and
funding cuts, there had been even less emphasis on disease prevention and health education. One participant stated that recent public funding
streams for both primary and mental health care focus on trauma and demand more requirements individuals need to meet in order to be
seen. Some participants were already seeing the effects of this and its implication on the availability and cost effectiveness of medical services.
One explained, Patients are getting sicker and sicker and utilizing more resources, which in the end costs a lot more money to treat. Another
participant shared that this higher demand for services, coupled with under staffing due to budget cuts, has led to longer wait times, which
deter some in the community from seeking the care that they need, especially those who cannot easily take time off to see a doctor.
Participants who serve the Asian or Latino immigrant communities agreed that family is an important concept to incorporate in health
promotion. In the Latino community, participants expressed a need for programs that focus on family involvement because family can help
introduce and maintain better options, such as eating healthier. For the Asian families, parents are likely to be more mindful about seeking
care for themselves if the message emphasizes the importance of being there for their family, for their children to have fit and healthy parents
who are able to care for them until they become independent adults.
Suggestions to creating healthier communities were also shared by focus group and interview participants. Many participants believed that
community organizations can help hospital in disseminating health information and messages to their patients and members in local
communities because community organizations have the trust and linguistic and cultural competence in diverse communities that they serve.
Many community organizations have health educators who are playing this role already. Other community organizations build leadership
among their clients to help them disseminate healthy messages to the broader community. One of them explained, Our former clients are now
embedded within positions in the community, like parent representative on school board or promotora. Sometimes they refer people in the
community to us.
Different participants suggested that schools and clinics are natural partners in health promotion because of their access to patients, children
and families. Participants also suggested hospitals to work more with ethnic media to promote healthy messages (such as the family focused
ones suggested above) and access to prevention and treatment services. For instance, one participant, who had surveyed the Korean
community in Los Angeles a couple years ago, found that 70% of first generation respondents read the Korean language newspapers at least
twice a week. For certain sensitive topics, such as mental health, health providers need to work with the right messengers even if the message
is culturally sensitive. In addition to ethnic media, participants have suggested religious leaders who can incorporate health and reduce stigma
in their messages to their congregations. Churches, one participant added, are amazing places to connect to communities. For immigrant
74
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
communities, the some of the Consulates have also been an ally. Both the Mexican and Thai Consulates were mentioned as partners in
promoting healthy messages and resources to the community.
1. Childhood Immunization
The National Immunization Survey (NIS) has collected childhood immunization coverage since 1994. Coverage estimates for 2009 include
children born during January 2006 to July 2008 and focuses on the following vaccines: vaccine birth dose, Hepatitis A vaccine, pneumococcal
conjugate vaccine [PCV], and rotavirus vaccine for children aged 19 35 months. NIS data indicate that vaccination coverage increased in 2009
compared with 2008 for Hepatitis B birth dose (from 55.3% to 60.8%) and Hepatitis A (from 40.4% to 46.6%), but coverage for PCV ( 4 doses)
remained stable (80.4%). Full coverage for rotavirus vaccine was 43.9% among children born within 2 years of licensure (1). Coverage for
poliovirus (92.8%), measles, mumps, and rubella (MMR) (90.0%), Hepatitis B (92.4%), and varicella (VAR) (89.6%) vaccines continued to be at or
near the national health objective of 90%, although coverage for MMR and Hepatitis B vaccines decreased slightly in 2009. The percentage of
children who have not received any vaccines remained low (<1%). 16
Among racial and ethnic groups, for more recently recommended vaccines, the Center for Disease Control reported that:
PCV and rotavirus coverage was lower among black and multiracial children than among white children. Coverage for PCV also was lower
among Asian children.
Coverage for Hepatitis A was lower among black children and American Indian/Alaska Native children than among white children. Except
for rotavirus coverage among black children, these differences persisted after controlling for poverty status.
Hepatitis B birth dose coverage was higher among Hispanic children than among white children. For vaccines with longer standing
recommendations, differences were observed for diphtheria, tetanus toxoid, and cellular pertussis (DTaP) vaccine. Compared with
coverage among white children, coverage was lower for black children for 3 and 4 DTaP doses and lower for Hispanic children for 4
doses only. The difference in coverage between white and black children for 4 doses remained statistically significant after controlling for
poverty status.17
And coverage by poverty status also varied, the NIS survey summarizes that coverage for:
Hepatitis B birth dose was higher among children living below poverty level than for those living at or above poverty level (by 3.8
percentage points).
16
17
2009 National Immunization Survey, Center for Disease Control and Prevention
2009 National Immunization Survey, Center for Disease Control and Prevention
75
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Among children living below poverty level, coverage was lower for 4 doses of PCV (by 8.4 percentage points) and rotavirus vaccine (by 9.4
percentage points) than for other children. Among the longer standing recommendations, coverage for 4 doses of DTaP also was lower
(by 5.6 percentage points).18
At the local level, Los Angeles Countys coverage for MMR vaccines was below the state (88.9% vs. 89.8%) and this pattern was also seen with
PCV doses. Los Angeles County had a higher percentage of childhood vaccination coverage than the state with Hepatitis B and A; and rotavirus.
Figure 55, from the NIS, outlines vaccination coverage at the national, state and county levels.
Figure 55. Estimated Vaccination Coverage for Vaccination Series (modified)* and Selected Individual Vaccines Among Children Aged 19 35
Months, by State and Local Area National Immunization Survey, United States, 2009
MMR ( 1 doses)
State/Area
PCV ( 4 doses)
Hep B (birth)
Hep A ( 2 doses)
Rotavirus**
Vaccine series
(modified)
(95% CI)
(95% CI)
(95% CI)
(95% CI)
(95% CI)
(95% CI)
United States
90.0
(0.8)
80.4
(1.1)
60.8
(1.3)
46.6
(1.4)
43.9
(1.4)
70.5
(1.2)
California
89.8
(3.7)
79.8
(5.1)
49.8
(6.3)
51.5
(6.3)
43.9
(6.1)
72.2
(5.5)
88.9
(5.4)
79.4
(6.7)
51.5
(8.1)
51.7
(8.0)
51.5
(8.1)
73.5
(7.2)
Rest of state
90.1
(4.7)
79.9
(6.5)
49.1
(8.1)
51.5
(8.0)
41.1
(7.8)
71.7
(7.1)
18
2009 National Immunization Survey, Center for Disease Control and Prevention
76
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2005
2002 03
Percentage
71.3%
Estimated #
737,000
Percentage
61.6%
Percentage
69.3%
77.6%
69.3%
72.4%
73.4%
51.0%
70.4%
73.7%
172,000
143,000
89,000
62,000
39,000
91,000
122,000
62.3%
62.7%
73.0%
62.0%
44.9%
64.5%
56.9%
73.0%
71.3%
68.4%
68.0%
49.5%
73.1%
71.9%
1999 00
Percentage
69.7%
73.7%
68.8%
69.0%
68.5%
54.2%
62.3%
80.2%
Sources: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
In Los Angeles County, pneumonia vaccination rates have steadily increased every year from 1999 to 2007 (54.9% vs. 55.7% vs. 57.7% vs. 60.5%)
and over half of the population across each SPA reported ever having a pneumonia vaccination. SVMCS SPAs, SPA 4 (54.6%) and 6 (51.1%) were
below the Los Angeles County rate (60.5%).
77
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 57. Percentage of Adults (65+ years) Reported Ever Having a Pneumonia Vaccination by SPA, 2007
Percent
60.5%
2007
Estimated #
599,000
67.6%
54.1%
54.6%
71.5%
51.1%
56.6%
63.9%
146
105
63
58
38
70
101
2005
Percent
57.7%
2002 03
Percent
55.7%
1999 00
Percent
54.9%
61.0%
61.4%
51.4%
57.4%
49.5%
55.6%
57.1%
61.7%
56.5%
50.4%
54.6%
44.2%
56.1%
55.0%
58.6%
53.8%
46.6%
60.1%
46.8%
51.0%
60.6%
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
3. Cholesterol Screening
The largest reported chronic condition in Los Angeles County is high blood cholesterol. Data from the 2007 Los Angeles County Health survey
reported that 29% of residents suffer with this condition. Several years prior to 2007, the reported percentage was lower at 16.1%. SPA data
indicate similar trends. Both SPA 4 and 6 in SVMCs primary service area reported lower percentages of adults diagnosed with high blood
cholesterol (26.0% and 25.5%) than Los Angeles Countys estimate of 29.1%.
Figure 59. Percentage of Adults (18+ years) Diagnosed with High Blood Cholesterol by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)
Percentage
29.1%
Estimated #
2,154,000
2005
Percentage
23.7%
1999 00
Percentage
16.1%
29.1%
31.5%
26.0%
30.6%
25.5%
30.5%
29.6%
456,000
431,000
242,000
160,000
174,000
291,000
340,000
26.4%
23.0%
21.5%
21.8%
18.3%
27.1%
24.3%
18.0%
18.3%
15.3%
13.5%
11.0%
14.4%
17.2%
Source: 2007, 2005 and 1999 00 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health
78
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
4. Dental Care
Created to address the oral health needs of underprivileged children in Los Angeles County, the Childrens Dental Health Project and its
collaborative members (including the USC and UCLA Schools of Dentistry) conducted the most comprehensive county wide, oral health
assessment of underprivileged children. This project was guided by several alarming facts from the 2000 Surgeon Generals Report which found
that not only is oral health key to overall health, but poor dental health has become a silent epidemic for underprivileged children: dental
decay has become the leading common childhood disease, dental decay is five time more common than asthma, and children of lower economic
social status have 12 timed as many activity restricted days per year because of dental related illnesses.
The dental health project sampled children across Los Angeles County from the age groups of 2 5 years old, 6 8 years old, and 14 16 years old.
Samples were drawn from Women, Infants and Children (WIC) centers; Head Start programs; and schools. A total of 2,313 children were
examined across 59 sites. Overall findings demonstrated a high evidence of dental caries among the underprivileged that is, almost half (44%)
of surveyed underprivileged in the County had cavities, and an additional 29% showed signs of early dental caries.
More specifically, The Childrens Dental Health Project of Los Angeles County concluded that:
The highest dental caries prevalence rate occurred in White Hispanic elementary school students, followed by non White Hispanics,
Asians, and African Americans.
Almost one out of every four (21%) underprivileged children were uninsured and 60% were covered by a public program, such as Denti
Cal, Medicaid, or Healthy Families.
Nearly three fourths of the county wide sample was classified as needing dental care within 15 days; and 9% were in need of immediate
dental care within 24 hours.
Only 6% of those sampled used tap water as their main source of drinking water a significant free source of fluoride.
86% of parents were not following the recommended American Association of Pediatric Dentistry guidelines that children should visit the
dentist by his/her first birthday.
The study found that half of Los Angeles County dental offices and clinics were not serving children covered by Denti Cal and average wait times
for an appointment were 3.7 days for new patients and 3.5 days for existing patients. Furthermore, only 44% of dental facilities treated children
under the age of two.
To advance improvements of oral health for the underprivileged, project investigators suggest partnering with community based providers to
establish dental homes in tandem with medical homes, increase dentists participation in Denti Cal and Healthy Families, increase dental training
and oral assessments for younger children infants and toddlers, develop a community oral health workers/promotores program to promote
79
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
effective oral care and prevention, promote the importance of drinking fluoridated tap water and brushing with fluoridated toothpaste, and
integrate oral health programs into current nutrition programs.
5. Health Literacy
Healthy People 2010 defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic
health information and services needed to make appropriate health decisions. This capacity would include the ability to read and comprehend
prescription bottles, appointment slips, and the other essential health related materials required to successfully function as a patient (American
Medical Association). In other words, health literacy is the ability to read, understand, and act on health care information as simplified by the
Center for Health Care Strategies Inc. Health Literacy Fact Sheet.
Patients with low health literacy are characterized as less likely to understand physical written and oral information, or successfully obtain
needed services by navigating the health care system, or follow directions in taking medications and appointment schedules. Those lacking
appropriate levels of literacy are more likely to have higher health care costs as well. According to the National Adult Literacy Survey:
Two thirds of American adults age 60 and over have inadequate or marginal literacy skills.
Half of welfare recipients read below the 5th grade level.
Half of Hispanic/Latinos and 40% of African Americans have some degree of reading difficulty.19
Research studies indicate that poor health status is disproportionately higher among patients with low functional health literacy. Those with low
health literacy are more likely than those with higher levels of health literacy to have a chronic disease and not get the health care they need.
Furthermore, emergency room patients who lack appropriate health literacy skills are likely to need hospitalization twice as often, after
controlling for self reported health status, health insurance coverage and income level.20
The Office of Minority Health, which is a division within the U.S. Department of Health and Human Services, created the National Standards for
Culturally and Linguistically Appropriate Services with the purpose to improve communication between providers and patients from racially and
ethnically diverse backgrounds. Locally, California is considering legislation to direct medical schools to provide training in cultural competency
and/or health literacy skills. The National Board of Medical Examiners has implemented a clinical skills test as part of the U.S. Medical Licensing
Examination to asses a doctors level of communication skills. Results from the Health People 2010 report indicated that much effort is still
needed to increase provider patient communication. Health communication survey items asking patients 18 years and older if health providers
19
20
Center for Health Care Strategies, Inc., Health Literacy Fact Sheet
Center for Health Care Strategies, Inc., Health Literacy Fact Sheet
80
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
always listen carefully to them, explain things so they can understand, show respect for what they have to say, or spend enough time with them
were each down by double by digits based on the Healthy People performance targets.21
21
81
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 59. Prevalence of Physical Activity for Adults (18+ years) by SPA, 2007
2007
2005
Percentage Estimated #
Los Angeles
County
53.2%
Metro (4)
West (5)
South (6)
51.8%
10.7%
793,000
36.2%
2,687,000
55.3%
10.2%
Percentage
Estimated #
3,749,119
48.0%
10.6%
769,916
10.1%
689,879
37.5%
2,712,284
41.8%
2,903,900
869,000
160,000
50.1%
10.6%
769,181
163,416
48.2%
10.3%
698,383
148,188
34.6%
543,000
39.2%
601,973
41.5%
608,729
50.4%
698,000
51.4%
676,441
44.6%
552,714
10.2%
141,000
11.6%
152,126
11.9%
147,593
39.4%
545,000
37.1%
488,173
43.5%
556,121
3,225,601
53.7%
500,000
53.6%
488,853
52.9%
432,141
11.2%
105,000
10.7%
97,769
9.1%
77,201
35.1%
327,000
35.7%
325,642
38.1%
325,441
57.3%
298,000
61.9%
330,114
56.3%
281,163
11.2%
58,000
11.3%
59,985
11.3%
55,846
31.4%
163,000
26.8%
142,784
32.4%
168,837
51.6%
349,000
45.6%
300,295
45.4%
272,744
Percentage Estimated #
3,951,000
2002 03
9.5%
64,000
9.8%
64,802
7.9%
49,645
38.9%
263,000
44.5%
293,226
46.7%
290,305
51.9%
495,000
51.5%
478,185
48.3%
415,264
12.1%
115,000
10.2%
94,788
8.1%
67,536
36.0%
343,000
38.3%
356,078
43.7%
390,549
53.7%
621,000
52.5%
590,063
45.7%
478,356
11.3%
131,000
10.0%
112,965
11.2%
122,565
35.0%
405,000
37.5%
421,527
43.1%
471,352
Source: 2007, 2005 and 2002 03 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
82
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2007
Average
2.1
2005
Average
2.4
2002 03
Average
2.4
2.0
1.8
2.2
1.6
3.1
2.1
2.0
2.4
1.8
2.6
2.3
3.3
2.3
2.5
2.2
2.5
2.6
1.7
2.7
2.2
2.5
1999 00
Average
2.4
2.3
2.1
2.3
2.1
2.6
2.4
2.9
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.
83
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
access to fresh fruits and vegetables, there is not much difference among the zip codes in this primary service area, with percentages ranging
from 39.5% (90008) to 46.2% (90017).
Figure 61. Percentage of those Consuming 5 Fruits and Vegetables per Day (Population 5 and Over) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Percentage
44.2%
44.5%
44.7%
43.5%
39.5%
43.0%
43.1%
41.0%
46.2%
41.1%
43.3%
42.8%
44.3%
44.2%
45.0%
44.4%
43.3%
42.0%
42.6%
45.8%
45.0%
There is however a larger fruit and vegetable consumption difference among Service Planning Areas, with a range from 12.7% in the South to
22.7% in the West in 2007. In SVMCs primary service area, SPA 4 (15.3%) has a slightly larger percentage of those eating 5 or more servings of
fruits and vegetables than Los Angeles County (15.1%) while SPA 6 has a smaller percentage (12.7%).
84
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 62. Percentage of Adults (18+ years) Reported Having Eaten 5 or More Servings of Fruits/Vegetables in the Past Day by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)
Percentage
15.1%
Estimated #
1,080,000
17.0%
13.5%
15.3%
22.7%
12.7%
13.8%
13.6%
258,000
178,000
136,000
111,000
83,000
128,000
152,000
2005
Percentage
14.6%
13.0%
15.3%
15.0%
19.4%
10.7%
13.9%
16.6%
2002 03
1999 00
Percentage Percentage
12.3%
11.6%
13.2%
12.2%
12.1%
17.8%
8.9%
11.4%
11.3%
13.1%
11.9%
11.0%
13.2%
9.9%
9.8%
11.9%
Source: 2007 and 2005 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
85
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 63. Percentage of Parents of Children (2 17 Years) Who Reported Their Child Ate Breakfast Daily in a Typical Week by SPA, 2007
Percentage
84.2%
86.5%
84.1%
85.7%
80.8%
87.0%
81.6%
82.4%
2007
Estimated #
2,112,000
430,000
373,000
245,000
81,000
282,000
301,000
322,000
2005
Percentage
77.2%
77.5%
76.3%
77.6%
80.8%
75.8%
78.8%
75.8%
Source: 2007 and 2005 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.
86
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 64. Percentage of Children (2 17 Years) Who Ate Fast Food Yesterday by SPA, 2005
2005
Percentage Estimated #
25.8%
633,000
24.2%
26.6%
24.7%
17.4%
24.9%
28.7%
28.2%
117,000
116,000
65,000
17,000
79,000
109,000
106,000
2002 03
Percentage
17.5%
1999 00
Percentage
21.0%
17.1%
18.9%
18.1%
13.4%
16.6%
18.9%
16.4%
20.3%
25.4%
23.5%
18.7%
18.5%
16.8%
22.5%
Source: 2005, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.
D. RISK BEHAVIORS
1. Obesity
Obesity is cited by focus group and interview participants as one of the major and most complex health concerns today. It also represents one of
the worst health trends in recent years, especially among children and among Latinos. One participant described it as a soaring trend, but not a
new one, that just keeps worsening. Some low income communities have a prevalence of fast food restaurants but are limited in access to
fresh fruits and vegetables. Access to fast food is not only easy in these communities, but it is also one of the few affordable choices for low
income families. As one participant stated, Obesity is hardly just a medical issue. There is no pill to take. Its also a city planning issue that has
to do with how we access food, what kind of food, open space, community violence, and so forth.
1.1 Overweight and Obesity
In 2007, 57.4% of the population age 12 and over in Los Angeles County were either overweight or obese. Both service planning areas in SVMCs
primary service area, SPA 4 and SPA 6, had an increase in overweight/obesity rates from 2003 2005 to 2007. SPA 6 (65.2%) had a higher rate of
overweight/obesity than the Los Angeles County. In SPA 6, over one third (34.4%) of its population were obese in 2007, up from 23.8% in 2003
2005.
87
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 65. Percentage of Overweight and Obese (12+ years) in Los Angeles County by SPA, 2007
Overweight
(BMI >25 and <30)
2007
2003 2005
34.8%
35.0%
Obese
(BMI 30+)
2007
2003 2005
22.6%
20.8%
Total
(BMI 25+)
2007
2003 2005
57.4%
55.8%
34.4%
34.7%
36.7%
32.5%
30.8%
41.0%
33.1%
20.4%
20.7%
18.3%
12.7%
34.4%
26.6%
25.4%
54.8%
55.4%
55.0%
44.2%
65.2%
67.6%
58.5%
35.2%
33.9%
33.4%
32.5%
38.0%
37.3%
34.4%
19.0%
20.4%
17.6%
13.7%
23.8%
26.7%
22.9%
54.2%
54.3%
51.0%
45.2%
61.8%
64.0%
57.3%
In 2003 2005, 12 out of the 21 zip codes in this primary service area had a majority of their population ages 12 and over who were overweight or
obese. The zip code with the highest rate of overweight/obesity during those years was 90008, at 59.8%. Please see Figure 66 for more detail.
Figure 66. Percentage of Overweight and Obese (12+ years) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
Overweight
(BMI >25 and <30)
31.2%
31.4%
33.1%
31.4%
34.3%
29.1%
35.9%
34.7%
33.7%
34.7%
31.7%
Obese
(BMI 30+)
17.3%
17.3%
19.5%
18.8%
25.5%
13.6%
22.8%
23.6%
19.8%
23.7%
19.6%
Total
(BMI 25+)
48.5%
48.9%
52.6%
50.2%
59.8%
42.7%
58.7%
58.3%
53.5%
58.4%
50.3%
Zip Code
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Overweight
(BMI >25 and <30)
28.6%
31.9%
30.5%
31.8%
31.9%
30.7%
35.2%
33.8%
32.1%
32.2%
Obese
(BMI 30+)
14.6%
17.8%
15.9%
17.5%
18.2%
17.3%
23.6%
25.4%
15.9%
18.3%
Total
(BMI 25+)
43.2%
49.7%
46.4%
49.3%
50.1%
48.0%
58.8%
59.2%
48.0%
50.5%
88
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2. Smoking
Note: Please note that data in this section has not been updated since the 2007 community needs assessment.
Cigarette smoking is the leading cause of preventable death in the United States and is a risk factor for diseases such as cardiovascular disease,
respiratory disease, and lung cancer (LACDPH, 2010). Each year nearly 9,000 lives and $4.3 billion are lost to smoking related disease in Los
Angeles County. In 2005, approximately 15%, or nearly one out of every six adults 18 years and older smoked cigarettes in Los Angeles County.
This is down approximately 4% from the late 1990s.
Smoking decreased in Los Angeles County from 2002 (15.2%) to 2005 (14.6%) as well as in five of the six SPAs, except SPA 6, which is in
SVMCs primary service area, where smoking increased from 2002 (15.3%) to 2005 (17.3%).
In 2005, the percent of adult smokers in SVMCS primary service area is larger than the percent of adult smokers in Los Angeles County
(16.4% in SPA 4 and 17.3% in SPA 6 vs. 14.6%).
Figure 67. Percentage of Adults (18+ years) who Smoke Cigarettes by SPA, 2005
2005
Percentage Estimated #
14.6%
1,067,000
14.5%
12.9%
16.4%
13.3%
17.3%
10.7%
16.7%
223,000
171,000
150,000
71,000
115,000
101,000
190,000
2002 03
Percentage
15.2%
1999 00
Percentage
18.1%
1997
Percentage
18.2%
14.6%
14.3%
16.8%
13.7%
15.3%
14.7%
16.4%
18.1%
15.4%
20.3%
19.2%
19.1%
17.1%
18.4%
18.8%
18.6%
18.8%
13.3%
18.9%
19.0%
17.4%
Source: 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of
Public Health.
89
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 68. Percentage of Adults (18+ years) Who Are Current, Non Regular, Former and Non Smokers by SPA, 2007
Metro (4)
West (5)
South (6)
2007
Percentage
Estimated #
14.3%
1,061,000
1.1%
79,000
21.2%
1,572,000
63.5%
4,713,000
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
13.3%
0.9%
25.5%
60.2%
209,000
15,000
401,000
946,000
11.9%
1.0%
19.1%
68.1%
163,000
14,000
262,000
936,000
15.7%
1.2%
20.1%
63.0%
146,000
12,000
188,000
587,000
2005
Percentage
13.9%
0.8%
23.3%
62.1%
13.9%
0.5%
26.3%
59.3%
11.9%
1.0%
22.6%
64.5%
15.5%
0.9%
23.2%
60.4%
2002 03
Percentage
14.4%
0.9%
22.9%
61.8%
13.9%
0.7%
24.7%
60.7%
13.2%
1.1%
20.5%
65.2%
15.8%
1.0%
22.9%
60.2%
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
9.7%
51,000
13.1%
13.1%
26.7%
63.4%
140,000
332,000
27.0%
59.6%
24.4%
61.8%
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
19.7%
1.2%
16.9%
62.3%
133,000
8,000
114,000
422,000
16.1%
1.3%
20.0%
62.6%
13.9%
1.3%
19.6%
65.1%
90
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
East (7)
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
Current Smoker
Non Regular Smoker
Former Smoker
Non Smoker
2007
Percentage
Estimated #
13.8%
131,000
1.6%
16,000
19.2%
183,000
65.4%
625,000
15.5%
0.9%
20.4%
63.3%
179,000
10,000
235,000
730,000
2005
Percentage
10.0%
20.8%
68.5%
15.9%
0.8%
22.1%
61.2%
2002 03
Percentage
13.3%
*
1.5%
20.4%
64.8%
16.0%
0.5%
25.2%
58.3%
Source: 2007, 2005, 2002 03 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
* The estimate is statistically unstable (relative standard error > 23%) and therefore may not be appropriate to use for planning or policy purposes.
19. Estimates may differ from prior estimates as new weights were utilized beginning March 20, 2006.
91
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 69. Percentage of Parents of Children (0 17 Years) Who Reported Their Child Exposed to Tobacco Smoke in the Home by SPA,
2005
2005
Percentage Estimated #
6.4%
178,000
6.6%
4.9%
3.2%
3.7%
10.7%
5.3%
7.6%
36,000
24,000
10,000
4,000
38,000
22,000
34,000
2002 03
Percentage
7.5%
1999 00
Percentage
11.1%
5.4%
7.4%
7.6%
6.9%
9.3%
6.6%
8.2%
11.2%
9.3%
9.6%
13.9%
10.6%
11.2%
11.8%
Source: 2007, 2005, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.
3. Alcohol Use
Although moderate alcohol consumption is common among adults with no adverse effects, alcohol abuse can cause medical consequences such
as cardiovascular disease, hypertension, cancer, and liver disease (LACDPH, 2001). Approximately 100,000 deaths each year can be attributed to
alcohol and an estimated $184.6 billion is spent on alcohol related problems each year in the U.S. (LAC/DHS 2001). In Los Angeles County in
2005, more than half of adults (53.6%) reported drinking alcohol in the past month, and approximately one in six (17.3%) admitted to binge
drinking (five or more drinks for men or three or more drinks for women) at least once in the past month. One out of every 25 adults, or 4.3%,
admitted to consuming 60 or more drinks in the past month. For 2007, alcohol use in SVMCs primary service area SPA 4 (49.7%) and SPA 6
(43.3) is lower than Los Angeles County (52.0%).
92
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 70. Percentage of Adults (18+ years) Who Reported Drinking Alcohol in the Past Month by SPA, 2007
2007
Percentage Estimated #
52.0%
3,877,000
60.8%
47.2%
49.7%
64.7%
43.3%
45.1%
52.9%
960,000
651,000
465,000
336,000
295,000
432,000
613,000
2005
Percentage
53.6%
61.8%
49.4%
51.1%
68.9%
38.7%
47.7%
56.2%
2002 03
1999 00
Percentage Percentage
54.3%
54.4%
59.1%
50.8%
52.7%
70.6%
44.0%
49.7%
55.4%
58.2%
52.7%
53.1%
67.2%
44.2%
49.8%
56.1%
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
Percentage
16.2%
Estimated #
1,190,000
2005
Percentage
17.3%
16.2%
13.8%
18.3%
12.8%
17.9%
18.5%
15.9%
253,000
188,000
169,000
66,000
121,000
174,000
183,000
18.3%
16.1%
19.2%
17.4%
13.7%
17.8%
17.6%
Source: 2007, 2005 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
* Binge drinking for females is drinking 4 or more drinks and males 5 or more drinks on one occasion at least one time in the past month.
93
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Percentage
3.3
Estimated #
242,000
2005
Percentage
4.3
4.0
2.6
3.8
2.7
3.4
2.6
3.5
63,000
35,000
34,000
14,000
23,000
24,000
40,000
4.7
3.6
5.3
4.5
3.1
2.9
5.5
Source: 2007, 2005 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
* Chronic/Heavy drinking is males consuming more than 60 drinks and females more than 30 drinks in the previous month.
4. Drug Use
In 2007, approximately 2% (153,000) of Los Angeles County adults were treated for substance abuse or addiction in the past five years.
Compared to Los Angeles County, SVMCs primary service area reported higher substance abuse rates (2.1% for SPA 4, and 3.0% for SPA 6). SPA
6 (3.0%) had one of the highest proportions of adults receiving drug abuse treatment across Los Angeles County.
Figure 73. Percentage of Adults (18+ years) Who Reported Receiving Treatment for Substance Abuse or Addiction by SPA, 2007
2007
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
Percentage
2.0
Estimated #
153,000
2.2
1.5
2.1
1.7
34,000
20,000
20,000
9,000
94
2007
South (6)
East (7)
South Bay (8)
Perce
entage
3
3.0
0
0.9
2
2.9
Estim
mated #
21,000
9
9,000
33,000
Source: 2007 Los Angeles County Health Survey; Office of Health Asssessment and Epidemiiology, LA
County Department off Public Health.
22
Figure 74. Re
eports of Gang Membership by County,
2006 200
08
%
%
t
Kidsdata.org
95
6. Youth Arrest//Felonies
Juvenile felony arrest rates weree on the declinee from 1998 to
2004 among youth ages 10 to 17
7. However from
m 2005 through
2008 the rates haave slightly increeased across the state and most
populated countties. Statewide, the majority off felony arrest
cases involved boys, ages 13
3 17, and adoleescent African
Americans. In 20
008, youth were arrested on felo
ony charges for
property offense
es (39.3%); violen
nt offenses, such
h as homicide,
rape, robbery, assault, and kidnaapping (27.0%); other offenses
like weapons or hit and run (23.2
2%); drug and allcohol offenses
(8.6%); or sex offfenses (2%). Thee rate of juvenilee felony arrests
varies by county, from 7.7 per 1,000 youth ages 10 17 in
Humboldt Countyy to 34.7 in San Francisco in 2008
8. Keep in mind
that the rate of arrests can be influenced by multip
ple factors, and
are an imperfect measure of juven
nile criminal activvity.
08
1,000)
23
Kidsdata.org
96
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
E.
CHRONIC DISEASE
Focus group and interview participants cited repeatedly chronic diseases as one of the top health issues facing their communities, including
diabetes, asthma, heart disease, and hypertension. The trend is not only apparent among adults, but it is also increasing for youth and children
in recent years. Many recent immigrants, including the undocumented, provide cheap labor in the informal, low wage, underground economy
that has become even more challenging during the recession. One participant referred to these immigrants as a permanent underclass.
Speaking specifically about Thai immigrants in this economy, one participant said that they experience a lot of stress and tension that has to do
with cultural displacement and dislocation, so they suffer from poor diet, high cholesterol, and high blood pressure or hypertension.
1. Diabetes
The prevalence of diabetes has been increasing across the globe and is now considered a worldwide pandemic. In Los Angeles County alone,
diabetes is the sixth leading cause of death since 1997 and an important cause of premature death since 1999 (LACDPH, 2010). Across SPA
(excluding SPA 6), Los Angeles County and California, the prevalence of diabetes has increased from 2003 to 2007. In 2007, 18.1% of adults ages
45 and over, almost 1 in 5, were diagnosed with diabetes, including borderline and pre diabetes. This is an increase from 14.6% in 2003 2005
and is also higher than the prevalence rate in California (15.9%). In SVMCs primary service area, SPA 4 significantly decreased from 2005
(20.8%) to 2007 (14.5%). SPA 6, however, increased from 2005 (22.2%) to 2007 (22.5%) and has the highest prevalence of diabetes among
adults age 45 and over.
97
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 76. Comparison of Prevalence of Diabetes among Adults Age 45 and Over By SPA, 2007
25.0%
22.2%
20.8%
20.0%
18.1%
16.7%
16.1%
14.6%
14.4%
13.8%
13.1%
15.9%
15.0%
22.5%
20.8%
19.2%
17.2%
14.5%
14.2%
11.8%
8.9%
10.0%
2007
5.0%
2003 2005
0.0%
In 2003 2005, 17 of the 21 zip codes SVMCs primary service area had a higher prevalence of diabetes than Los Angeles County. The zip code
with the highest prevalence rate was 90037 (21.2%).
Figure 77. Percentage Diagnosed with Diabetes*(Adults Age 45 and Over) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
Los Angeles County
Percentage
14.9%
15.7%
17.3%
19.8%
20.5%
16.2%
20.9%
14.6%
Zip Code
90016
90017
90018
90019
90020
90026
90027
Percentage
19.7%
18.0%
20.6%
16.2%
14.4%
15.6%
12.7%
Zip Code
90028
90029
90031
90037
90044
90046
90057
Percentage
14.2%
15.7%
16.9%
21.2%
20.9%
11.6%
17.0%
98
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
State
13.8%
2. Asthma
In 2007, 11.8% of the population in Los Angeles County was diagnosed with asthma, which was comparable to the rate in 2003 2005. SVMCs
SPA 6 had an increase in percentage from 2003 2005 to 2007 (11.7% to 12.8%) but SPA 4 had a slight decrease (9.5% to 9.2%).
Figure 78. Percentage Diagnosed with Asthma by SPA, 2007
Percentage
2007
2003 2005
11.8%
12.0%
12.1%
11.4%
9.2%
13.9%
12.8%
9.8%
13.4%
11.5%
11.8%
9.5%
12.0%
11.7%
12.1%
13.7%
In 2003 2005, 2 out of the 21 zip codes in this primary service area for SVMC had an asthma diagnosis rate higher than that of the County. Zip
code 90008 had the highest rate of asthma diagnosis during those years (13.0%).
Figure 79. Percentage Diagnosed with Asthma (All Ages) in SVMCs Primary Service Area, 2005
Zip Code
90004
90005
90006
90007
90008
90010
90011
Percentage
9.1%
8.7%
8.6%
10.0%
13.0%
9.5%
8.9%
99
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Zip Code
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Los Angeles County
Percentage
11.3%
8.2%
11.0%
10.5%
9.2%
9.2%
10.9%
10.6%
9.1%
8.9%
10.1%
12.2%
11.4%
8.7%
12.0%
In 2007, 7.9% of the population under 18 years of age in Los Angeles County was diagnosed with asthma. This is a decrease by almost 1% from
2005 and a 0.2% decrease from 2002 03. SVMCs SPAs 4 and 6 both showed a decrease in diagnosis rates from 2005 to 2007 (6.7% to 4.1% for
SPA 4 and (9.0% to 7.8% for SPA 6). While SPA 6 is consistent with the rate for Los Angeles County, SPA 4 is lower.
Figure 80. Percentage of Parents of Children (0 17 Years) Who Reported Their Child Ever Diagnosed with Asthma and Currently Still Have
Asthma or Had an Asthma Attack in the past 12 months, 2007 by SPA, 2007
2007
Percentage
Estimated #
7.9%
220,000
8.0%
7.6%
4.1%
7.6%
7.8%
8.8%
44,000
36,000
13,000
9,000
29,000
36,000
2005
Percentage
8.8%
7.9%
8.3%
6.7%
4.9%
9.0%
8.8%
2002 03
Percentage
8.1%
8.7%
8.4%
5.6%
13.0%
6.0%
7.7%
100
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
9.5%
42,000
11.0%
8.8%
Source: 2007, 2005, and 2002 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.
Rate
67
16
46
90
164
*
123
Zip Code
90016
90017
90018
90019
90020
90026
90027
Rate
130
65
66
74
25
68
36
Zip Code
90028
90029
90031
90037
90044
90046
90057
Rate
37
64
81
205
180
12
117
3. Heart Disease
Overall, the prevalence of heart disease has increased every year in Los Angeles County from 1997 (4.8%) to 2007 (7.7%). Most SPAs in the
Metro Collaborative fall under Los Angeles Countys rate of eight percent (7.7%) of residents diagnosed with heart disease, except SPA 8 (9.0%).
Ten year percentage increases in heart disease by SPA averages around 2.7% compared to 2.9% across Los Angeles County. SVMCs SPAs 4 and
6 both show an increase in the percentage of adults diagnosed with heart disease from 2005 to 2007 (5.7% to 7.5% for SPA 4 and 6.4% to 7.6%
for SPA 6).
Figure 82. Percentage of Adults (18+ years) Diagnosed with Heart Disease by SPA, 2007
2007
Percent Estimated #
7.7%
578,000
7.4%
117,000
4.9%
6.9%
1997
Percent
4.8%
4.2%
101
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2007
Percent Estimated #
7.9%
109,000
7.5%
70,000
5.8%
30,000
7.6%
51,000
7.5%
72,000
9.0%
104,000
1997
Percent
5.2%
4.2%
4.0%
4.9%
5.1%
5.8%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA
County Department of Public Health
4. Arthritis
Note: Data in this section has not been updated since the 2007 community needs assessment.
The percentage of adults diagnosed with arthritis is larger than the percentage of adults diagnosed with heart disease. However, the rise in the
percent of adults 18 years and older diagnosed with arthritis is less compared to the percentage of adults diagnosed with heart disease. Overall,
the prevalence of arthritis has increased every year in Los Angeles County from 1999 (16.4%) to 2005 (18.1%).
SVMCs SPA 4 (14.9%) fell below Los Angeles Countys rate (18.1%) of residents diagnosed with arthritis but SPA 6 ranked above (20.8%). Both
SPAs 4 and 6 showed an increase from the 2002 2003 rates (12.5% and 15.8%).
Figure 83. Percentage of Adults (18+ years) Diagnosed with Arthritis by SPA, 2005
2005
2002 03
Percent Estimated # Percent
18.1%
1,313,000
15.7%
17.5%
17.6%
14.9%
15.3%
20.8%
18.0%
270,000
231,000
137,000
81,000
137,000
169,000
15.6%
17.7%
12.5%
10.6%
15.8%
14.2%
1999 00
Percent
16.4%
15.5%
18.9%
15.0%
13.1%
15.7%
17.5%
102
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
20.5%
233,000
17.8%
15.8%
Source: 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
2007
Percentage
Estimated #
29.1%
2,154,000
29.1%
31.5%
26.0%
30.6%
25.5%
30.5%
29.6%
456,000
431,000
242,000
160,000
174,000
291,000
340,000
2005
Percentage
23.7%
1999 00
Percentage
16.1%
26.4%
23.0%
21.5%
21.8%
18.3%
27.1%
24.3%
18.0%
18.3%
15.3%
13.5%
11.0%
14.4%
17.2%
Source: 2007, 2005 and 1999 00 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health
103
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 85. Percentage of Adults (18+ years) Diagnosed with Hypertension by SPA, 2007
2007
2005
Percentage Estimated # Percentage Estimated #
24.7%
1,837,000
23.4%
1,699,940
23.7%
24.2%
24.8%
19.3%
29.0%
25.3%
25.0%
373,000
335,000
232,000
101,000
197,000
242,000
289,000
21.4%
24.5%
22.1%
16.8%
29.0%
23.9%
24.5%
330,164
324,552
202,274
88,831
192,491
223,297
278,219
2002 03
Percentage
20.1%
1999 00
Percentage
19.1%
1997
Percentage
15.8%
18.6%
19.7%
18.1%
16.5%
25.1%
19.9%
22.6%
18.9%
19.8%
19.0%
15.0%
20.1%
17.9%
20.4%
14.5%
17.6%
13.8%
13.2%
22.1%
16.0%
15.5%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health
F.
CANCER
104
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2005
Percentage
38.1%
38.7%
36.2%
35.6%
40.4%
43.3%
36.4%
Estimated #
910,000
2002 0319
Percentage
32.8%
203,000
175,000
93,000
75,000
75,000
106,000
34.0%
30.8%
32.9%
32.8%
33.6%
30.6%
105
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
40.2%
159,000
35.6%
Source: 2005 and 2002 03 Los Angeles County Health Survey; Office of Health Assessment and
Epidemiology, Los Angeles County Department of Health Services.
2007
Percentage Estimated #
84.4%
2,697,000
83.7%
81.3%
84.6%
87.3%
562,000
488,000
328,000
202,000
2005
Percentage
83.8%
2002 03
Percentage
85.4%
1999 00
Percentage
76.8%
1997
Percentage
72.8%
84.2%
84.1%
82.8%
85.6%
85.6%
83.2%
81.1%
88.2%
77.0%
72.4%
73.8%
81.7%
74.2%
73.3%
66.8%
76.4%
106
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2007
Percentage Estimated #
88.3%
269,000
85.0%
342,000
84.8%
423,000
South (6)
East (7)
South Bay (8)
2005
Percentage
83.3%
84.9%
83.2%
2002 03
Percentage
89.9%
85.2%
87.4%
1999 00
Percentage
78.1%
75.7%
81.6%
1997
Percentage
71.0%
70.3%
76.5%
Source: 2007, 2005, 2002 03, 1999 00, 1997 Los Angeles County Health Surveys; Office of Health Assessment and Epidemiology, Los Angeles County
Department of Public Health
2007
Percentage
Estimated #
73.7%
1,591,000
75.4%
72.4%
68.5%
78.5%
72.0%
77.0%
73.3%
359,000
303,000
164,000
127,000
125,000
205,000
258,000
2005
Percentage
70.6%
2002 03
Percentage
73.5%
1999 00
Percentage
73.7%
1997
Percentage
70.7%
69.7%
72.4%
64.9%
71.7%
69.1%
74.6%
71.0%
73.4%
74.5%
70.1%
73.7%
71.6%
73.2%
75.4%
73.9%
72.5%
70.8%
76.1%
73.0%
73.6%
77.2%
68.3%
76.0%
67.6%
74.7%
70.3%
65.3%
72.7%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
107
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 89. Percentage of Women (50+ years) Reported Having a Mammogram in the Past Two Years by SPA, 2007
2007
Percentage
Estimated #
77.9%
1,087,000
77.9%
76.4%
73.6%
77.5%
81.1%
79.6%
79.7%
238,000
211,000
114,000
84,000
87,000
138,000
180,000
2005
Percentage
75.2%
2002 03
Percentage
77.9%
1999 00
Percentage
79.0%
1997
Percentage
76.2%
73.8%
77.5%
67.4%
76.9%
79.8%
80.3%
73.4%
78.6%
78.6%
70.7%
78.5%
78.2%
78.7%
80.0%
81.0%
79.0%
73.6%
84.1%
81.9%
76.5%
81.1%
73.9%
82.1%
72.6%
77.5%
78.9%
70.8%
76.8%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services
G.
HIV/AIDS
1. HIV/AIDS
As of December 2009, the HIV/AIDS Semi annual Surveillance Summary reported a total 56,091 diagnosed AIDS cases; 26,643 living cases and
31,448 reported deaths in Los Angeles County. Since 2005 the number of diagnosed AIDS cases has steadily dropped, from 2008 to 2009 the
number of diagnosed cases dropped by half (1,148 to 574). AIDS related deaths have also dropped since 2005, with the most notable drops
occurring from 2006 to 2007 (542 to 316, difference of 226) and 2008 to 2009 (282 to 127, difference of 155). With the number of related
deaths declining, the number of cases of individuals living with AIDS has slightly increased from 21,635 in 2005 to 24,643 in 2009.
108
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 90. Cases of AIDS by Year of Diagnosis and Deaths among AIDS Cases, Los Angeles County, 2009
Diagnosed
Cases
Year
2005
1,449
Deaths
Living
Cases
570
21,635
2006
1,370
542
22,463
2007
1,183
316
23,330
2008
1,148
282
24,196
2009
574
56,091
127
31,448
24,643
Cumulative*
Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010
* The total count of cases since 1982.
By SPA, the number of AIDS cases reported annually has steadily declined since 2005. From 2005 to 2009, the number of reported AIDS cases
dropped from 464 to 178 for SPA 4 and from 191 to 72 for SPA 6. Please see Figure 92 for the number of AIDS cases by year for each SPA.
Figure 91. Annual Cases of AIDS by SPA, 2009
Los Angeles County
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
West (5)
South (6)
East (7)
South Bay (8)
2009
574
2008
1,148
2007
1,183
2006
11,370
2005
1,449
62
53
178
25
72
45
125
152
87
388
42
149
77
231
154
73
379
32
143
66
288
176
98
445
67
168
82
316
189
94
464
65
191
90
332
Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010
In 2009, gender by ethnicity numbers for persons living with AIDS in SVMCs primary service area SPAs 4 and 6, reveal that the majority of
reported cases were Hispanic males (4,214), White males (3,737), and Black males (2,386). The largest occurrence of male and female persons
living with AIDS is in SPA 4 (9,251). Please see Figure 92 for more details.
109
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 92. Number of persons living with AIDS in SVMCs Primary Service Area by Gender and Ethnicity by SPA, 2009
San Fernando (2)
Male
Female
Gender
White
Black
Hispanic
Metro (4)
Male
Female
Male
West (5)
Female
South (6)
Male
Female
East (7)
Male Female
1,383
117
346
51
3,654
96
744
48
83
20
211
23
295
68
203
86
1,392
180
170
35
994
305
83
25
1,145
141
784
128
3,318
306
270
27
896
196
1,038
183
Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010
Data were not available for South Bay (8)
From 2005 to 2007, the number of deaths among AIDS cases declined within SVMCs primary service area. However, in 2007, the largest
number of AIDS related deaths in Los Angeles County occurred in SPA 4 (111), followed by 47 deaths in SPA 6.
Figure 93. Number of Deaths Among AIDS cases by SPA, 2007
2007
2006
2005
Los Angeles County
316
542
570
Service Planning Area
San Fernando (2)
35
69
81
San Gabriel (3)
21
45
42
111
195
201
Metro (4)
10
24
31
West (5)
47
69
63
South (6)
24
28
32
East (7)
62
101
114
South Bay (8)
Source: Los Angeles County Public Health HIV/AIDS Semi Annual Surveillance Summary 2010
24
110
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
In Los Angeles County, from 1982 through 2009 there were 292 diagnosed adolescent AIDS cases. The highest reported number of adolescent
AIDS cases in KFH LAs service area was in the Metro Service Planning Area with 74 cases among 13 to 19 year olds. In 2007, 60 adolescents were
living with AIDS in Los Angeles County. This is low compared to 2002 2004, where the numbers were in the high sixties. The most affected
racial/ethnic subgroup were Hispanic/Latinos with 30 reported adolescent cases, followed by African Americans with 16 reported adolescent
cases, and Whites with 5 cases. The total number of adolescent AIDs related deaths was 49 from 1982 to 2009, at a rate of less than 5 deaths
annually.25
H.
COMMUNICABLE DISEASES
1. Tuberculosis
The national tuberculosis (TB) rate in the United States has declined every year since 1993. From 2000 to 2008, the rate of TB cases decreased
by an annual average of 3.8%. Disproportionally higher cases of TB still remain for foreign born residents and minorities, especially for African
Americans (2009). From 2003 to 2007, the rate of TB cases in Los Angeles County also decreased, with 2007 being the fifteenth year of decline
since 1992. Also in 2007, the number of TB cases decreased by 8.2% from 2006. Despite the overall decreasing trend, Los Angeles County
accounted for the highest number of TB cases in 2007: 2,725 cases or 29.9% (LADPH, 2008).
Figure 94. TB Cases and Rates (Cases per 100,000 population) for Los Angeles County, 2007
% of Rate of
Change
Year
Cases
Population
Rate
2003
949
9,398,128
10.1
2004
930
9,535,937
9.8
3.4%
2005
906
9,582,956
9.5
3.1%
2006
885
9,644,738
9.2
2.9%
2007
816
9,689,462
8.4
8.2%
According to 2007 Los Angeles County Department of Public Health data, TB affected (see Figure 95):
Males 1.5 times more than females (61.4% vs. 38.6%).
Individuals age 15 34 years (23.2%) and age 65 years and older (23.5%)
More foreign born individuals (79.3%)
25
2010 Los Angeles County Public Healths HIV/AIDS Semi Annual Surveillance Summary
111
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
A larger number of Hispanics/Latinos (358 cases or 43.9%) and Asian Americans (329 cases or 40.4%). But the infection rate was the
highest in Asian Americans (27.7 per 100,000), followed by African Americans (10.3 per 100,000)
Of those reported with TB in Los Angeles County during 2007, 7.9% were co infected with HIV. Of those with HIV and TB, the majority
were male (89.1%); Hispanic/Latino (64.1%); and in the 25 44 year age group (56.1%).
Figure 95. TB Cases and Rates (Cases per 100,000 population) by Gender, Ethnicity and Age for Los Angeles County, 2007
2003
2004
2005
2006
2007
Cases
Rate
Cases
Rate
Cases
Rate
Cases
Rate
Cases
Rate
Gender
Female
383
8.0
360
7.5
365
7.5
340
7.0
315
6.4
Male
566
12.2
570
12.1
541
11.4
545
11.4
501
10.4
Asian
346
27.7
337
26.6
323
25.8
329
25.9
329
25.6
African American
90
10.3
100
11.3
97
11.2
86
10.2
74
8.7
Hispanic/Latino
434
9.9
426
9.5
426
9.4
394
8.5
358
7.7
White
Native American/Alaskan
Native
78
2.7
67
2.3
58
2.0
75
2.6
54
1.9
3.5
0.0
3.5
3.5
0.0
00 04
21
3.1
24
3.4
24
3.3
28
3.9
25
3.4
05 14
17
1.1
20
1.3
12
0.8
13
0.9
0.6
15 34
246
8.8
216
7.8
206
7.4
219
7.8
189
6.7
Race/Ethnicity
Age Group
35 44
158
11.1
151
10.0
187
12.4
134
8.9
117
7.8
45 54
150
12.7
164
13.1
165
12.9
157
12.1
150
11.4
55 64
119
15.9
130
15.9
111
13.2
131
15.1
134
15.1
65+
238
22.9
225
23.2
201
20.7
203
20.7
192
19.0
112
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
2. Hepatitis A
Viral hepatitis is caused by at least five different types of viruses. In the United States, acute viral hepatitis infections are most often caused
through the Hepatitis A virus (HAV), Hepatitis B virus (HBV), or Hepatitis C virus (HCV). These unrelated viruses are transmitted through different
routes and have varied adverse effects on the body. Vaccines are available for the first two types of hepatitis viruses. HBV has been available
since 1981 and HAV has been available since 1995 (Center for Disease Control, 2007). The Hepatitis A virus is preventable through the use of
vaccines. In fact, HAV rates are declining most for children in those states that had implemented the vaccine starting in 1999 (CDC, 2007). This
virus is transmitted from fecal matter to mouth, person to person and through food.
According to the 2008 LACDPH Annual Morbidity Report, the 2008 incidence rate in Los Angeles County was the same as the prior year 0.82
per 100,000 population vs. 0.80 per 100,000 population. This rate is lower than the statewide rate of 1.22 and the national rate of 0.86.
Hepatitis A occurred most often for those between the ages of 15 34 (1.2 per 100,000) and Asians (1.1 per 100,000). Reported cases for both
SPAs in SVMCs primary service area were low, SPA 4 7 cases (.5%) and SPA 6 2 cases (.2%).
Figure 96. Reported Hepatitis A, Acute Cases and Rates per 100,000 by SPA, 2008
Cases
Percentage
Rate/
100,000
17
21.3%
0.8
17
21.3%
1.0
Metro (4)
8.8%
0.5
West (5)
10
12.5%
1.5
South (6)
2.5%
0.2
East (7)
15
18.8%
1.1
8.8%
0.6
3.
Hepatitis B
In the United States, Hepatitis B is a chronic infection that is the leading cause of chronic liver disease and cancer of the liver. Acute Hepatitis B
is more prevalent and infectious than AIDS (LADHS, 2008)26. It is transmitted through blood and bodily fluids of infected individuals and from
mother to child after birth. Chronic infections are more common among infants and children than adults.
26
113
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
The Center for Disease and Control reports that the frequency of HBV cases was down 82% (8.2 cases per 100,000) in 1990. In 2007 the number
of cases was down 15% (1.5 cases per 100,000). However, in Los Angeles County, the incidence rate for acute Hepatitis B increased from 0.57
cases per 100,000 in 2007 to 0.68 cases per 100,000 in 2008 (LADHS, 2008)27.
In Los Angeles County, Hepatitis B affected most those between the ages of 55 64 (1.5 per 100,000); four times as much in males; and African
Americans (1.8 per 100,000). In SVMCs primary service area, SPA 6 had the highest rate of infection (2.1 per 100,000). Of the 22 cases in SPA 6,
eight were caused by an outbreak at a Long Term Care Facility (LADHS, 2008). SPA 4 had an infection of rate of 0.5 per 100,000, and seven cases
of acute Hepatitis B.
Figure 97. Reported Hepatitis B, Acute Cases and Rates per 100,000 by SPA, 2008
Cases
Percentage
Rate/
100,000
13.6%
0.4
9.1%
0.3
Metro (4)
10.6%
0.5
West (5)
13.6%
1.4
South (6)
22
33.3%
2.1
East (7)
9.1%
0.4
6.1%
0.4
4. Hepatitis C
Hepatitis C is the most common blood borne infection in the United States (LADHC, 2008)28. However, surveillance of HCV remained difficult
because there is no one laboratory test that identifies cases (LADHC, 2008). An estimated 3.2M Americans are chronically infected with HCV. It
affects 600,000 California residents, causing 1,000 1,200 deaths in the state per year and is expected to triple in the next 20 years (Center for
Health Improvement, 2005)29. It is more common in Californias prison population with an estimated 41% of inmates infected with Hepatitis C.
27
114
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
From 2001 to 2003, the crude case rate of newly reported cases and the average number of cases were higher for LA County compared to
California (CA Department of Health Services, 2005)30.
In 2008, there were five cases of confirmed acute Hepatitis C in Los Angeles County, an increase from two cases confirmed in 2007. In SVMCs
primary service area, there were no cases of acute Hepatitis C reported in 2008.
Figure 98. Reported Hepatitis C, Acute Cases and Rates per 100,000 by SPA, 2008
Cases
Percentage
Rate/
100,000
60.0%
0.1
20.0%
0.1
Metro (4)
0.0%
0.0
West (5)
0.0%
0.0
South (6)
0.0%
0.0
East (7)
0.0%
0.0
20.0%
0.1
5. Pertussis
During 2010, the Center for Disease Control reported several states are experiencing an increase in cases and/or localized outbreaks of pertussis,
including a state wide epidemic in California.31 In fact, as of August 2010, the Los Angeles County Health Department issued a pertussis health
alert. Los Angeles Countys occurrence of pertussis related deaths is currently at its highest in 15 years. In June 2010, the state of California
issued an epidemic of pertussis. The current year to date total number of confirmed or probable cases in Los Angeles County surpassed totals
for 2009. Pertussis is most serious in infants less than three months of age.32 Pertussis, or whooping cough, a highly contagious respiratory
disease that is caused by a bacterial infection, is preventable through vaccine. However, even the vaccinated can sometimes still become
infected because protection lasts only 5 to 10 years. Recently a pertussis vaccine has become available for preteens, teens, and adults.33
30
115
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Over the last 5 years, 8,000 25,000 cases of pertussis were reported per year in the United States.34 The June 2010 California Pertussis Summary
Report, concluded to date there have been 1,337 cases of pertussis; resulting in a state rate of 3.4 per 100,000. This equates to five times the
amount reported over the same period in 2009 (258 cases). Furthermore, if these current trends continue, California will report more cases of
pertussis than in the last 50 years. Los Angeles County pertussis rates range from 0 to more than 70 cases per 100,000. Rates are highest among
infants less than 6 months of age (69.6 per 100,000), children 7 9 years (10.2 per 100,000) and adolescents aged 10 18 years (9.3 per 100,000).
Rates by race/ethnicity are highest among Whites (3.3 per 100,000). Rates by age and race reveal that Hispanic infants less than 6 months of
age are most affected (94.2 per 100,000) and Whites aged 7 9 years (15.8 per 100,000).35
Figure 99. Pertussis Rate per 100,000 Population of Reported Cases*, by Race/Ethnicity and Age in California, January 1 June 30, 2010
White
Hispanic
API
Black
<6 mos
Rate
36.6
94.2
19.1
43.1
6 mos 6 yrs
Rate
6.1
3.4
0.5
2.6
7 9 yrs
Rate
15.8
4.3
1.9
2.5
10 18 yrs
Rate
14.4
3.4
2.8
1.3
19 64 yrs
Rate
1.0
0.6
0.2
0.3
65+ yrs
Rate
0.7
0.6
0.3
0.0
Source: Center for Disease Control and Prevention, Vaccines and Immunizations, Pertussis
*Out of 982 cases with known information
From 2006 to 2007 the Los Angeles County (LAC) Immunization Programs Fall Assessment found that the fourth dose of DTaP coverage in LAC
fell below the Healthy People 2010 target for kindergarteners and continues to be the most frequently missed childhood vaccine in Los Angeles
County and in the United States.36 The 2004 2008 five year average of confirmed and probable pertussis cases was 77.0. Specifically, in 2009
there were 53 reported cases of pertussis (0.51 per 100,000)37 and during the second quarter of 2009, the majority of pertussis cases occurred in
children less than one year of age (52.5%, n=31) followed by the 15 34 age group (15.3%, n=9) and 45 54 age group (8.5%, n=5).
In SVMCs primary service area, there were a larger number of cases reported than in Los Angeles County. SPA 6 reported the highest
number of cases (14) and SPA 4 reported 10 cases.38
34
Center for Disease Control and Prevention, Vaccines and Immunizations, Pertussis
LA County Department of Public Health Immunization Program, California Pertussis Summary Report (6/30/2010)
36
County of Los Angeles Department of Public Health, 2007 Annual School Immunization Assessment, Preschool and Kindergarten
37
LA County Department of Public Health Immunization Program, California Pertussis Summary Report (6/30/2010)
38
County of Los Angeles Department of Public Health, Vaccine Preventable Disease Surveillance Report, Quarter 2, 2009
35
116
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
117
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
I. MENTAL HEALTH
Mental health services was consistently cited by focus group and interview participants as one of the least available services in the community.
More than most health issues, mental health illnesses carry a lot of stigma in communities of color. For instance, participants suggested that
cultural norms and biases in Latino and African American communities sometimes deter potential patients from seeking mental health care.
Similar perception was found in the Asian community. One participant said that mental health issues continued to be stigmatized in the Thai
community even after the Thai Consulate brought mental health professionals from Thailand to educate the community.
There are also structure problems that make mental health care less accessible. Participants stated that many community clinics do not have
mental health professionals on staff and referrals to mental health services are limited by what is available in the community. Some participants
also cited the restricted nature of mental health funding and the priority of trauma over prevention. One participant explained, DMH
[Department of Mental Health] doesnt allow for a mental wellness approach which a lot more people can benefit from. It doesnt allow for
creativity. We have a partner in the community who has been able to expand their healing center to offer acupuncture, traditional
psychotherapy, yoga and other movement classes. It integrates a little bit of Eastern philosophy, all at no cost or cost. None of this was
fundable by DMH.
Unfortunately, the reduction in mental health services comes at a time of economic recession when the demand for these services sharply
increases. Participants believed that unemployment and foreclosure are two major stressors that lead to an increase in depression and anxiety,
which in turns leads to poor management of existing health and chronic conditions. Mental health issues tend to impact recent immigrants
disproportionately, especially during economic downturn. One participant said, A lot of low income immigrant families are suffering from some
type of depression and anxiety, as well as the somatic issues that could arise from it. In addition to adjustment to an unfamiliar dominant
culture, many recent immigrants find themselves in a tightening underground economy where it is harder to eke out a living. This is coupled
with a harsh political environment that calls for more immigration control. For example, in the Korean community, according to participants
who serve that community, stress from coping with a bad economy has led to a rise in alcoholism, family violence and suicides.
118
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
of children in Los Angeles County ages 3 to 17 years (22,000) whose parents were unable to afford mental health services for them in the past
year. In SPA 4, the second highest in Los Angeles County, there were an estimated 17,000 children whose parents were unable to afford mental
health services for them in the past year. Please see Figure 100 for more data.
Figure 100. Percentage of Children (3 17 years) Unable to Afford Mental Health Care or Counseling in the Past Year by SPA, 2007
Percentage
4.2%
3.5%
3.3%
2.9%
6.3%
3.9%
7.1%
3.4%
4.3%
Estimated #
100,000
3,000
16,000
12,000
17,000
4,000
22,000
12,000
16,000
Source: 2007 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.
Total #
69
34
43
25
43
1
59
11,692
34,967
Zip Code
90016
90017
90018
90019
90020
90026
90027
Total #
49
27
52
50
29
72
108
Zip Code
90028
90029
90031
90037
90044
90046
90057
Total #
82
32
35
42
66
97
37
119
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
3. Depression
Since the last community needs assessment in 2007, the most frequently cited mental health issue continues to be depression. Similarly, focus
group and the Los Angeles County Health Survey (LACHS) indicate that depression diagnosis in Los Angeles County has increased every year from
1999 to 2007 (see Figure 103). Women, older adults, and Native Americans, in particular, had the highest rates of depression in Los Angeles
County.
Almost 14% of respondents in the LACHS reported being diagnosed with depression in 2007, a 4% increase from 2002 and a 5% increase from
1999. This is higher than the estimated 6.7 percent of adults in the United States in a given year affected by depression (NIMH, 2008). Although
depression among both males and females increased from 1999 to 2007, females showed a greater increase (11.0% to 16.6%). Depression also
increased among all age groups. Respondents between the ages of 50 59 years reported the highest level of depression (19.0%) followed by
those between the ages of 60 64 years (18.2%).
In 2007, 13.6% of adults in Los Angeles County were diagnosed with depression (up from 12.9% in 2005). In SVMCs primary service area, the
percentage of adults diagnosed with depression in 2007 was equal to or higher than Los Angeles County (13.6% in SPA 6 and 14.6% in SPA 4).
From 2005 to 2007, the largest increase occurred within SPA 4 (from 11.9% to 14.6%). SPA 6 also experienced an increase of 12.2% in 2005 to
13.6% in 2007 (Figures 102 103).
120
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 102. Percentage of Adults (18+ years) Diagnosed with Depression in SVMCs Primary Service Area, 2007
Source: 2007, 2005, 2002 03, 1999 00 Los Angeles County Health Surveys; Office of Health Assessment and Epidemiology,
Los Angeles County Department of Public Health
Figure 103. Percentage of Adults (18+ years) Diagnosed with Depression by SPA, 2007
2007
Percentage
Estimated #
Los Angeles County
2005
Percentage
2002 03
Percentage
1999 00
Percentage
13.6%
1,009,000
12.9%
9.7%
8.8%
13.5%
212,000
12.8%
10.4%
9.7%
12.4%
171,000
11.2%
9.0%
7.2%
Metro (4)
14.6%
136,000
11.9%
11.0%
9.6%
West (5)
13.2%
69,000
16.6%
11.7%
8.8%
South (6)
13.6%
92,000
12.2%
7.0%
6.9%
East (7)
13.4%
128,000
13.2%
9.7%
8.7%
13.8%
159,000
13.7%
9.4%
9.8%
121
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Source: 2007, 2005, 2002 03, 1999 00 Los Angeles County Health Surveys; Office of Health Assessment and Epidemiology, Los Angeles County
Department of Public Health
19. Estimates may differ from prior estimates as new weights were utilized beginning March 20, 2006.
2007
Percentage
Estimated #
5.3%
126,000
5.8%
4.5%
5.2%
6.8%
4.8%
3.4%
6.9%
27,000
19,000
13,000
6,000
14,000
12,000
26,000
2002
Percentage
4.5%
1999
Percentage
5.3%
5.7%
4.0%
2.2%
5.8%
4.1%
4.2%
4.5%
4.9%
5.1%
5.1%
7.4%
6.1%
4.4%
5.5%
Source: 2007, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.
122
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
J.
1. Domestic Violence
Actual domestic violence (DV) numbers are difficult to measure due to inconsistent data on the occurrence and circumstances of each DV event
and dissimilar data sources. For example, data sources may be reported at the national, state or local level and information is collected
dependent upon that agencys mission or focus. County DV statistics are culled from three sources: law enforcement and criminal justice
systems, the healthcare and public health systems, and self reported surveys. More importantly, none of the aforementioned data sources are
linked in any way that could present a more complete view of the cycle of DV.42
Domestic violence data is reported in the following categories: severe cases like homicides, hospitalizations for DV related injuries, emergency
room visits, and self reported victimizations. Additionally, DV victimization without severe physical injury cases is less likely to be reported
therefore true numbers are unknown.43
Overall, the number of state and County DV related incidences is on the decline. The number of deaths due to assaultive injuries (homicides)
among adolescent and adult females ages 10 44 saw a quick drop off from the three year period of 1997 1999 to the next three year period
from 1998 2000; following that six year span to 2004 2006 existed a constant decline; however, it has been minimal. Starting in 1997 1999, the
County three year rate per 100,000 female deaths due to homicide was higher than the state three year rate (3.8 per 100,000 vs. 3.2 per
100,000). More recently, Los Angeles County has seen larger decreases in the rate of DV related homicides than the state.44
Figure 105. Domestic Violence Death Due to Homicide Among Females (ages 10 44 years), 2006
Three Year
Average
1994 1996
1995 1997
1996 1998
1997 1999
1998 2000
1999 2001
2000 2002
Number
387
350
300
277
256
253
257
California
86% Confidence Interval
Rate
Lower
Upper
4.6
4.1
5.0
4.1
3.7
4.5
3.5
3.1
3.9
3.2
2.8
3.6
2.9
2.6
3.3
2.9
2.5
3.2
2.9
2.5
3.2
Number
146
129
114
96
98
93
99
42
LA Department of Public Health, Domestic Violence Data Sources, Injury & Violence Prevention Program
LA Department of Public Health, Domestic Violence Data Sources, Injury & Violence Prevention Program
44
LA County Department of Public Health
43
123
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Three Year
Average
2001 2003
2002 2004
2003 2005
2004 2006
Number
264
246
234
230
California
86% Confidence Interval
Rate
Lower
Upper
2.9
2.6
3.3
2.7
2.4
3.0
2.5
2.2
2.9
2.5
2.2
2.8
Number
94
90
85
87
Note: Because there is no domestic violence specific external cause of injury (E Code) in the current Classification of Diseases (ICD) codebook, the
numerator in this template reflects deaths due to all types of assault except data for California 2000. Prior to 1999, ICD 9 codes E960 E969 were
used; after 1999. ICD 10 codes U01 U02, X85 Y09 and Y87.1 were used. Data from California Department of Public Health, Epidemiology and
Prevention for Injury Control (EPIC) Branch does not include ICD 10 code Y87.1 for assault (homicide) by all other and unspecified means and the
sequelae.
Source: California Department of Public Health, Center for Health Statistics, OHIR Vital Statistics Section, 1994 2005
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1970 2050, Sacramento, California, May
2004
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California, July 2007
In 2006, Los Angeles County reported 0.4 per 100,000 female (13 and over) hospitalizations due to assaultive injuries by a spouse or partner;
almost half the rate compared to the state at 0.7 per 100,000 female hospitalizations over the same year. Historically, the number of County
reported DV hospitalization cases are less frequent than state trends.45
Figure 106. Domestic Violence Hospitalizations Due to Violent Injuries Among Females (ages 13 and over), 2006
Year
Number
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
199
157
141
156
120
90
103
124
129
102
California
95% Confidence Interval
Rate
Lower
Upper
1.5
1.3
1.7
1.2
1.0
1.4
1.0
0.9
1.2
1.1
1.0
1.3
0.9
0.7
1.0
0.6
0.5
0.8
0.7
0.6
0.8
0.8
0.7
1.0
0.9
0.7
1.0
0.7
0.5
0.8
Number
38
37
38
33
31
21
26
23
30
18
Note: ICD 9 CM Diagnosis E967.3 Perpetrator or child or adult abuse by spouse or partner or by ex spouse or ex partner
45
124
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Sources: California Office of Statewide Health Planning & Development, Patient Discharge Data. Prepared by California Department of Public
Health
Epidemiology & Prevention for Injury Control (EPIC) Branch, Injury Surveillance & Epidemiology Section. Data retrieved on September 22, 2008.
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1990 1999, Sacramento, California, May
2004.
Denominator Data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California, July
2007.
Historically, spousal abuse arrest rates have been similar between California and Los Angeles County. For example in 2006, 1.4 per 1,000 adults
18 and over was arrested in Los Angeles County for a domestic violence incidence and 1.6 per 1,000 was arrested statewide.46
Figure 107. Domestic Violence Adult Arrests for Spousal Abuse, 2006
California
Year
Total
Male
Female
Rate
1997
1998
1999
2000
2001
63,636
56,892
52,128
51,225
53,778
47,519
43,104
41,885
9,858
9,373
9,024
9,340
2.7
2.4
2.2
2.1
52,392
42,662
9,730
2.1
2.1
50,479
40,885
9,594
2.0
48,854
39,325
9,529
46,353
45,083
43,911
37,235
36,116
32,264
9,118
8,967
8,647
2002
2003
2004
2005
2006
Total
Male
Female
Rate
18,725
17,190
15,776
14,706
15,819
14,330
13,029
11,911
2,907
2,860
2,747
2,795
2.9
2.6
2.3
2.1
2.1
15,227
12,351
2,876
2.2
2.1
2.2
1.9
2.0
13,899
11,234
2,665
2.0
1.9
2.0
1.9
1.8
1.9
12,931
10,485
2.2446
1.8
1.8
1.8
1.7
1.7
1.6
1.7
1.7
1.6
1.8
1.7
1.6
11,911
11,206
10,741
9,633
9,120
8,665
2,278
2,088
2,076
1.6
1.5
1.4
1.6
1.5
1.4
1.7
1.6
1.5
Sources: California Department of Justice Statistics Center, Review of Domestic Violence Statistics, 1990 2003, Data retrieved June 12, 2007.
California Department of Justice Statistics Center, Special Request Unit, 2004 2005 data received by fax June 11, 2007.
California Department of Justice Statistics Center, Special Request Unit, 2005 data received by fax September 23, 2008.
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1970 2050, Sacramento, California, May 2004.
Denominator Data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California, July 2007.
From 1997 to 2002, Los Angeles County received a higher rate of domestic violence phone assistance calls to a law enforcement agency. This
trend has reversed starting in 2003. From 2003 to 2006 the state received more DV assistance calls. The current County DV assistance phone
call rate is 5.9 per 1,000 adults ages 18 and over versus 6.4 per 1,000 statewide.47
46
47
125
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 108. Domestic Violence Related Calls for Assistance in the Adult Population (ages 18 and over), 2006
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006*
Number
of Calls
220,156
196,832
186,406
196,880
198,031
196,569
194,288
186,439
181,362
176,299
California
86% Confidence Interval
Rate
Lower
Upper
9.5
9.4
9.5
8.3
8.3
8.4
7.7
7.7
7.7
7.9
7.9
8.0
7.8
7.8
7.9
7.6
7.6
7.7
7.4
7.4
7.4
7.0
7.0
7.0
6.7
6.7
6.7
6.4
6.4
6.5
Number
of Calls
67,805
62,278
59,834
60,960
59,661
56,661
56,452
48,041
45,684
43,508
Note: Currently there is no standard definition of or reporting system for domestic violence. Domestic violence is a complex issue involving many
social and psychological forces. Therefore, reliance on a single indicator does not present a complete picture of the problem. The begin
addressing these barriers, it is important to identify the existing data sources and understand their advantages and limitations. Local police
jurisdictions mandated reporting on domestic violence related calls for assistance is one data source commonly used to describe the
frequency of domestic violence in California, because it is population based and easily accessible. However, these data only illustrate local
law enforcement practices and response to domestic violence calls and are not an adequate source for measuring either the prevalence or
incidence of domestic violence injuries.
*Data cannot be broken down by age; therefore, calls included both adults and juveniles.
Sources: California Department of Justice Statistics Center, Division of Law Enforcement, Law Enforcement Information Center Special Report,
Total Domestic Violence Calls Received by Type of Weapon, by County, 1990 2001.
California Department of Justice Statistics Center, California Criminal Justice Profile, 1998 2005.
California Department of Justice Statistics Center, Special Request Unit, 2006 data received by email on September 23, 2008.
Denominator data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 1990 1999, Sacramento, California,
May 2004.
Denominator Data: California Department of Finance, Race/Ethnic Population with Age & Sex Detail, 2000 2050, Sacramento, California,
July 2007.
In Los Angeles County, over two thirds of DV related emergency calls to law enforcement involved weapons, such a firearms; knives; other
weapons; and hands, fists or feet.
126
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 109. Domestic Violence Related Calls for Assistance Involving Weapons, 2006
Los Angeles County
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Firearm
781
622
612
682
637
753
671
513
528
460
*Data cannot be broken down by age; therefore, calls included both adults and juveniles.
Sources: California Department of Justice Statistics Center, Division of Law Enforcement, Law Enforcement Information Center Special Report, Total Domestic Violence Calls Received by Type of
Weapon, by County, 1990 2001.
California Department of Justice, Criminal Justice Statistics Center, California Criminal Justice Profile 1996 2005.
California Department of Justice, Criminal Justice Statistics Center, Special Request Unit, 2006 data received by email September 23, 2008.
African American
White
Hispanic
Asian/Pacific
Islander
Native American
Missing
TOTAL
69.2
19.8
19.8
6.2
69.7
33.9
21.6
127
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
65.7
15.4
19.1
5.0
45.1
11.7
20.5
3. Teenage Pregnancy
Each teen pregnancy cost taxpayers an average of $4,080 per year and each child born to a teen mother costs an additional $1,430 per year, for
an estimated total of $270 million every year in public health care, child welfare, incarceration, and lost tax revenue49. In Los Angeles County,
nearly 1 in 10 live births, or 15,000, was to women under the age of 19. The birth rate among Hispanic/Latinas from 15 17 years of age is 12
times higher than Asian teen mothers and 7 times higher than White teen mothers. The birth rate among African American teens 15 17 years of
age is 6.5 times higher than White teens.
In SVMCs primary service area, SPA 6 had the highest percentage of teen births in Los Angeles County at 13.5%. Additionally, SPA 4 was
higher than Los Angeles Countys 9.8 percent teen birth rate (2005)50.
4. Immigration
The United States immigrant population has nearly doubled from 1990 to 2006, from 20 million immigrants in 1990 to 37 million immigrants in
2006. The Urban Institutes MetroTrends 2008 found most immigrants originate from Latin America and Asia, and contribute diversity to
Americas top 100 metro areas. Californias immigrant population is still the largest in the nation and continues to increase; however, that
growth has slowed in the late 1990s and quickened in the 2000s.
In 2007, 26% of all immigrants relocated to California, down from 1990 (33%). Californias working age immigrant population grew 9.5%
annually from 1980 to 1990; however, it increased by half that by only 4.4% annually from 1990 to 2000, and half that by only 2% annually from
2000 to 2007. Historical immigrant destinations like Los Angeles County grew by only 1.8% per year from 1990 to 2007, compared to 11.9%
growth per year in Riverside County and 9.9% in Kern County. Alameda, San Bernardino, Riverside, Kern, and Sacramento Counties had the
fastest growing immigrant populations since 1990. The growth in Alameda and Sacramento Counties was due primary to an increase in new
immigrant arrivals, while growth in Kern, Riverside and San Bernardino stems more from relocation by more established immigrants. Riverside
and San Bernardinos relocation growth was mainly from Los Angeles County.51
49
128
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
A recent study led by The Public Policy Institute of California (PPIC), found that both documented and undocumented immigrants, particularly
Latinos, are moving to new locales that are outside traditional immigrant geographies and social networks to destinations based strongly on
better economic opportunities. Specifically, PPIC found that immigrants employed in the construction, manufacturing, and some service
industries are less likely to choose to live in California than they were in 1990. In 2000, new immigrants in California had higher levels of
education on average than in 1990. Furthermore, there was no evidence that the generosity of welfare programs affected choices. PPICs study
suggests that Californias ability to attract highly skilled immigrants to its workforce is linked to economic conditions relative to other states. In
addition, these demographic shifts have policy implications at the federal, state, and local level because many communities are confronting
issues of integrating immigrants for the first time.52
In California, the largest immigrant population in 2008 originated from Latin American (54.6%), and nearly one third of that population resides in
Los Angeles County. In addition, nearly one third of the Asian immigration population in California resides in Los Angeles County (please see
Figure 111 for details). In Los Angeles County, a large percentage of the immigration population in 2008 originated from Latin American (59.9%)
and Asia (32.1%). The same was true in the 2007 community needs assessment; however, there was a larger percentage of Asians (32.1%) in
2007 than in 2005 (27.4%). In 2009, 41.0% of foreign born people were born in Mexico (smaller percentage than California, 43.3%)53.
Figure 111. Foreign Born Population in Los Angeles County 2008 estimates
Europe
Asia
Africa
Oceania
Latin American
Northern American
% of population
5.4%
32.1%
1.4%
0.4%
59.9%
0.9%
Estimated #
186,069
1,112,673
49,705
12,873
2,076,954
31,985
California (%)
6.9%
34.8%
1.5%
0.8%
54.6%
1.4%
Estimated # in CA
683,972
3,431,501
144,966
75,589
5,387,639
135,212
The majority of the population in Los Angeles County that is foreign born are between the ages of 25 and 64 (49.8%), and 65 and above (42.5%),
much higher than in California (37.5% and 29.7%, respectively). Please see Figure 112 for more data.
Figure 112. Foreign born population by Age Group in Los Angeles County, 2008
Age group
04
5 17
52
53
% of population
2.2%
9.0%
California (%)
2.1%
8.35%
The Public Policy Institute of California, New Patterns of Immigrant Settlement in California, July 2009
U.S. Census Bureau, 2009, American Community Survey
129
18 24
25 64
65 and Above
27.4%
49.8%
42.5%
22.2
2%
37.5
5%
29.7
7%
5. School Drop
pouts
Kidsdata.org
130
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Public Healths Survey. SVMC SPA 4 (22.8%) and 6 (270.1%) reported a higher percentage of those in fair to poor health than Los Angeles County
(18.5%).
Figure 114. Percentage of Adults (18+ years) who Reported Fair/Poor Health Status by SPA, 2007
2007
Percentage Estimated #
18.5%
1,375,000
15.8%
19.4%
22.8%
7.4%
27.1%
19.1%
17.4%
249,000
267,000
213,000
39,000
183,000
183,000
202,000
2005
Percentage
20.6%
2002 0319
Percentage
20.3%
15.4%
19.1%
25.5%
10.6%
33.4%
23.2%
20.5%
17.3%
20.2%
23.4%
11.4%
28.5%
23.1%
19.8%
1999 00
Percentage
20.9%
15.4%
20.1%
28.5%
14.5%
28.2%
24.3%
19.9%
1997
Percentage
20.5%
14.7%
22.2%
24.9%
12.5%
31.5%
24.2%
17.9%
Source: 2007, 2005, 2002 03, 1999 00, 1997 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA County Department of Public Health.
2005
2002 03
1999 00
Average
5.4
Average
6.4
Average
6.1
Average
6.4
5.3
5.1
5.8
4.2
6.8
6.7
5.7
6.2
6.1
7.9
5.7
6.1
6.7
5.4
6.6
6.4
5.8
7.0
6.0
5.9
131
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
East (7)
South Bay (8)
5.1
5.3
6.2
6.2
6.2
6.1
5.8
7.2
Source: 2007, 2005, 2002 03, 1999 00 LA County Health Surveys; Office of Health Assessment and Epidemiology, LA
County Department of Public Health.
8. Carbon Monoxide
Good air quality is especially important for good health. The quality of air is one of Southern Californias biggest challenges. According to the
California Air Resource Board, by January of 2005, Southern Californians average carbon monoxide reading was 2.3 parts per million (ppm) and
by the end of the same year it doubled to 4.3 ppm. It is worth noting that monitoring of carbon monoxide (CO), nitrogen dioxide (NO2) and
sulfur dioxide (SO2) is not currently required anywhere in California.
132
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Zip Code
90029
90031
90037
90044
90046
90057
11. Housing
11.1 Housing Units
There are nearly 13 million households in the state (12,652,259) of California. And one in four households was located in Los Angeles County
(3,234,680).56 The distribution of the number of households across Service Planning Area show that the San Fernando area ranks highest with
the most number of households at 21.4%, followed by San Gabriel at 17.4% and South Bay at 15.9%.
55
CA Air Resource Board Particulate Matter (PM10) Air Pollution Fact Sheet, 2009
133
Percenttage of Los
Angele
es County
100%
S
Service
Planning Area
A
S Fernando (2)
San
702,175
21
1.7%
S Gabriel (3)
San
563,935
17
7.4%
M
Metro
(4)
West (5)
W
438,522
13
3.6%
296,203
9.2%
SSouth (6)
256,441
7.9%
East (7)
360,211
1.1%
11
515,512
15
5.9%
3,132,999
96
6.9%
C
Cumulative
3,234
4,680
Percentage of Los
Angeles County
A
100%
9000
04
23,8
817
0.74%
9000
05
16,4
478
0.51%
9000
06
20,0
088
0.62%
9000
07
13,1
122
0.41%
9000
08
13,4
493
0.42%
9001
10
Number of Households
Los Angeles County
Zip Codes
56
94
40
0.03%
9001
11
22,8
898
0.71%
9001
16
16,7
785
0.52%
HealthyCity.org, 20
009
134
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
90017
8,858
90018
0.27%
15,931
0.49%
90019
24,782
0.77%
90020
18,442
0.57%
90026
25,034
0.77%
90027
23,119
0.71%
90028
15,320
0.47%
90029
14,306
0.44%
90031
10,817
0.33%
90037
15,545
0.48%
90044
25,589
0.79%
90046
29,388
0.91%
90057
16,608
0.51%
Cumulative
371,360
11.48%
# Vacant Units
122,563
90004
23,952
764
90005
16,542
599
90006
20,343
915
135
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
90007
# Occupied Units
13,068
# Vacant Units
721
90008
13,670
762
90010
936
14
90011
22,572
1,821
90016
16,752
864
90017
8,939
638
90018
15,919
983
90019
24,593
1,016
90020
18,354
550
90026
25,071
1,444
90027
23,119
724
90028
15,320
641
90029
14,306
517
90031
10,817
521
90037
15,570
1,502
90044
25,321
2,148
90046
29,388
963
90057
16,265
930
136
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 120: Owner vs. Renter Occupied Housing Units in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
Service Area
Los Angeles County
In 2010, SPA 4 had the largest percentage of renters (76.9%) in all of Los Angeles County, followed by SPA 6 (58.9%). Subsequently, both SPA 4
and 6 had the smallest percentage of homeowners (23.1% and 41.1%, respectively).
Figure 121. Owner vs. Renter Occupied Housing Units by SPA, 2010
Service Planning Area
San Fernando (2)
San Gabriel (3)
Metro (4)
137
Service Plannin
ng Area
West (5)
South (6)
East (7)
South Bay (8)
Los Angeles County
Ow
wner Occupied Hou
using Units
12
23,291
41.4%
04,573
10
19
96,248
24
47,536
1,57
78,828
41.1%
54.5%
48.4%
48.5%
58.9%
45.5%
51.6%
51.5%
Structure
e with 20 49 Units
5,180
21.1%
%
5,740
33.6%
%
5,172
24.6%
%
2,193
15.9%
%
2,009
14.1%
%
219
23.0%
%
754
3.1%
%
848
4.8%
%
3,669
38.6%
%
1,419
8.4%
%
1,933
7.5%
%
7,225
38.0%
%
2,395
9.1%
%
4,746
19.9%
%
5,214
32.5%
%
2,758
18.1%
%
502
4.4%
%
138
Zip Code
e
90037
90044
90046
90057
Service Area
Los Angeles Co
ounty
Structure
e with 20 49 Units
934
5.5%
%
948
3.4%
%
6,487
21.4%
%
6,430
36.6%
%
66,775
17.1%
%
297,534
8.9%
%
139
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 124. Owner Occupied Median Home Values in SVMCs Primary Service Area, 2010
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
140
Figure 12
25. Number of Paassenger Cars, Vaans, and Pickup/Panel Trucks Kep
pt at Home and Made Available for
f Use by SPA, 2010
Number of Vehicle
es
N
None
1 Vehicle
2 Vehicles
3 Vehicles
4 Vehicles
5 Vehicles
T
Total
State of
California
954,982
7.6%
Los Angeles
County
San
Fernando
SPA (2)
305,159
9.4%
44,395
6.3%
4,029,228
31.9%
1,121,110
34.7%
4,761,045
37.6%
1,146,346
35.4%
1,946,827
15.4%
439,506
13.6%
670,089
5.3%
154,453
4.8%
290,088
2.3%
68,106
2.1%
12,652,259
3,234,680
San
n Gabriel
S
SPA
(3)
Metro
o SPA
(4
4)
West SP
PA
(5)
South SPA
(6)
South Bay
SPA (8)
5.8%
88,,785
20..3%
17,497
7
5.9%
43,985
17.3%
28,568
7.9%
43,152
8.4%
230,505
1
160,329
189,,063
127,56
60
97,333
108,227
181,605
32.8%
28.4%
43..2%
42.8%
%
38.2%
30.1%
35.3%
276,873
2
214,393
114,,389
111,47
78
70,001
129,220
188,127
39.4%
38.0%
26..1%
37.4%
%
27.5%
35.9%
36.6%
101,044
1
101,142
30,4
406
29,951
1
27,949
59,227
69,177
14.4%
17.9%
7.0
0%
10.1%
%
11.0%
16.4%
13.5%
34,963
3
37,810
9,7
771
8,282
2
9,994
24,380
23,136
5.0%
6.7%
2.2
2%
2.8%
3.9%
6.8%
4.5%
14,395
1
17,553
5,1
157
3,237
7
5,368
10,589
9,209
2.1%
3.1%
1.2
2%
1.1%
2.1%
2.9%
1.8%
702,175
5
563,935
437,,571
298,00
05
254,630
360,211
514,406
3
32,708
141
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
In California, more than four out of five residents (84.5%) remained in the same house more than one year; 14.7% moved to a different
residence and an additional 0.8% moved outside the Los Angeles County, 87.4% remained in the same house; 11.9% moved to a different
residence and an additional 0.7% moved abroad57.
11.8 Year Housing Structure was Built
In 2010, the majority of housing structures in Los Angeles County were built between 1950 1959 (21.1%), 1960 1969 (16.2%), and 1970 1979
(14.5%). The remainder of housing structures were built between 1939 or earlier (12.3%), 1940 1949 (11.7%), 1980 1989 (11.6%), 200 or later
(6.4%), and 1990 1999 (6.2%).
In SVMCs primary service area, the majority of homes were built in 1930 or earlier (26.1%), between 190 and 1959 (15.9%), or between 1960
and 1969 (14.7%).
11.9 Transition Services for Adults with Pediatric Illness
In 2005, more than one out of seven children (15.7%) in Los Angeles County met the criteria for having special health care needs.58 According to
Kidsdata.org, a comprehensive data and information website that provides over 300 indicators on the health and well being on Californias
children, reported that more than one third (37.1%) of Californias youth with special care needs received support services for the transition to
adulthood in 2005 2006. In the United States, slightly more youth (41.2%) received transition to adulthood support services than in California.
Based on Californias children with special health care needs (CSHCN) statistics, almost half (42.2%) of CSHCN received care within a medical
home that is, a basic level of care that is ongoing, comprehensive, coordinated, and family centered. Measures of transitional support services
are vital given the overall increases in childhood chronic conditions such as asthma; attention deficit/hyperactivity disorder (ADD/ADHD);
diabetes; and depression; and with the advances in medicine means longer survival rates for children who are living well into adulthood.59
12. Safety/Crime
In 2006, the California Department of Public Health reported a total of 802 homicides by firearms for Los Angeles County (California Department
of Public Health, 2006). In SVMCs primary service area, there were a total of 141 homicides by firearm. The highest number of homicides by
firearm occurred in zip codes 90011 (31), followed by 90044 (24).
57
142
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
#
7
0
7
0
10
0
31
9
0
13
6
0
8
0
0
0
0
20
24
0
6
143
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 127. Percentage of Children (1 17 Years) whose Parents Reported Easy Access to a Park, Playground or Other Safe Place for their Child
to Play by SPA, 2007
Percentage
79.8%
83.9%
85.3%
69.7%
87.5%
62.6%
85.0%
83.1%
2007
Estimated #
2,124,000
443,000
391,000
206,000
94,000
218,000
339,000
351,000
2005
Percentage
83.1%
83.9%
87.4%
73.1%
85.1%
72.1%
86.1%
90.0%
2002 03
Percentage
82.7%
86.7%
84.7%
72.4%
89.3%
70.3%
88.3%
85.6%
1999 00
Percentage
75.9%
77.9%
80.4%
68.4%
78.3%
62.7%
78.7%
81.5%
Source: 2007, 2005, 2002 and 1999 Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, LA County
Department of Public Health.
60
144
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
53.2%
2008
53.8%
2 Year Percentage
Change
0.6%
Asian/Pacific Islander
24.9%
20.9%
4.0%
Hispanic/Latino
10.1%
17.4%
7.3%
African American
5.3%
8.3%
3.0%
Race/Ethnicity
2006
White
Surveyed downtown respondents from 2006 and 2008 reported similar own versus rent residential living. Thirty percent owned their home
compared to 60% who rented; an additional 10% had other living arrangements. Nearly two out of three (63.5%) downtown residents worked in
the city in 2008 compared to more than one of two (55.1%) residents who reported working in the city in 2006. This upsurge may represent
residents choosing to live, work and play in Downtown. Seventy three percent of respondents admitting to spending their main activity dining
out in one of downtowns many trendy new restaurants or entertainment centers. In 2006, only 58% responded that their main downtown
activity was dining out.61
61
62
145
Figure 129
9. Los Angeles Co
ontinuum of Care
e by Sheltered an
nd Unsheltered Persons by SPA, 2009
Sheltered
Unsheltered
Tottal
Num
mber
LA Continuum of
o Care*
Number
14,050
Pe
ercentage
33%
Nu
umber
28
8,644
Percen
ntage
67%
%
1,515
46%
1
1,797
54%
%
3,312
1,010
36%
1
1,770
64%
%
2,780
Metro (4)
5,121
46%
5
5,972
54%
%
11,0
093
West (5)
1,707
31%
3
3,831
69%
%
5,538
South (6)
2,157
25%
6
6,357
75%
%
8,514
East (7)
1,236
27%
3
3,281
73%
%
4,517
810
21%
3
3,144
79%
%
3,954
Unknown SPA
50
9%
517
91%
%
56
67
42,6
694
Num
mber
Perccent
25862
13,,730
2,0
026
1,0
076
60%
32%
5%
%
3%
%
19,,886
12,,631
8,9
924
783
470
47%
29%
21%
2%
%
1%
%
146
A survey of home
eless persons in the City of Los Angeles and the Los Angeles Contiinuum of Care was administered from March thro
ough May of
2009. Survey results indicated th
hat homeless sub
bpopulations by gender were 60%
% adult male, 32
2% adult female, and 8% males and females
under the age of eighteen. Subpopulations by ethn
nicity reflected a majority of Africcan Americans (47%); followed byy Hispanic/Latinoss (29%), and
Whites (21%). The remaining 3% comprised of American Indian/Alaaskan Native and Asian/Pacific Islaanders.
2005
Number
1,013,000
0
e
Percentage
36.3%
Perccentage
28.3
144,000
34.1%
28.0
193,000
38.0%
32.1
o (4)
Metro
145,000
32.8%
31.7
West (5)
28,000
32.1%
13.3
h (6)
South
178,000
39.5%
31.1
7)
East (7
140,000
36.0%
20.9
159,000
38.1%
28.9
ngeles County
Los An
63
147
As previously me
entioned, not haaving sufficient food negatively affects certain age groups differrently. The dataa shows that in Los Angeles
66
County:
In 2007, 57.4% of adults were overweight or obese.
12.9% of children were co
onsidered overweeight for their agee.
h borderline or pre diabetes.
In 2009, 10.9% had diabettes and 0.9% werre diagnosed with
In 2007, in SVMCs primary servicee area:
SPA 6 (15
5.8%) had the higghest percentage of people with diabetes, and high
her than Los Angeeles County (10.9
9%).
Borderline/pre
ediabetic
0.9
ng Area
Service Plannin
San Fernando (2
2)
6.4
0.9
13.9
1.2
Metro (4)
8.3
0.8
unty
Los Angeles Cou
West (5)
8.3
0.8
South (6)
15.8
0.6
East (7)
12.7
0.6
12.4
0.9
66
California Health In
nterview Survey
148
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
149
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
called for more support for low income housing, including senior housing for those seniors who have lost their savings in the recession, as a way
to stabilize community health. One participant also stated that the recession causes situational depression, and by virtue of extreme poverty
and the stressors that come with it, also substance abuse, marital discords, and hopelessness in general. In addition to the depression and
anxiety, some participants also attributed an increase in diabetes rate to economic stress.
In
In 2009, 22% of alcohol distributors72 in California were located in Los Angeles County (California Department of Alcoholic Beverage Control). Of
the total alcohol distributors in Los Angeles County (14,176), 22% were located in SVMCs primary service area. The two zip codes with the
70
CA Employment Development Department, Monthly Labor Force Data for Counties, Preliminary October 2010
Los Angeles Economic Development Corporation, Kyser Center for Economic Research, Economic Forecast, July 2010
72
Alcohol distributors include bars, restaurant, liquor, grocery, and convenience stores.
71
150
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
highest number of alcohol distributors within the primary service area were zip codes 90028 (188), 90046 (130), 90010 (128), 90026 (102), and
90005 (96).
Figure 133. Number of Alcohol Distributors in SVMCs Primary Service Area, 2009
Zip Code
90004
90005
90006
90007
90008
90010
90011
90016
90017
90018
90019
90020
90026
90027
90028
90029
90031
90037
90044
90046
90057
#
88
96
128
48
14
51
76
38
60
28
83
92
102
99
188
79
48
41
42
130
47
151
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Figure 134. Number of Alcohol Distributors in SVMCs Primary Service Area, 2009
Figure 135. Percentage of Adults who Reported Binge Drinking* in the Past Year by SPA, 2009
2009
Estimated
Percent
#
2,014,000
27.0%
27.5%
22.1%
27.8%
29.2%
25.2%
30.2%
29.3%
424,000
313,000
261,000
150,000
173,000
301,000
333,000
2007
Percent
27.8
27.9%
21.2%
33.9%
31.4%
23.6%
30.5%
29.1%
Estimated #
2,038,000
425,000
294,000
298,000
163,000
158,000
289,000
342,000
152
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Zip Code
90026
90027
90028
90029
90031
90037
90044
90046
90057
153
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Characteristics
Primary Language
Participants
1
2
3
4
5
English
55
Spanish/English
English
English
14
English
Spanish
19
Spanish
20
Community Members
6
7
154
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
8
9
10
City/Site
Los Angeles/St. Barnabus
Senior Services
Los Angeles/Amanecer
Community Counseling
Services
Pasadena/ City of Pasadena
Human Services and
Recreation Department
Characteristics
Mixed ethnicity; seniors; males and
females.
Hispanic; mixed age group; males and
females; parents.
Mixed ethnicity; mixed age group;
males and females.
Primary Language
Participants
English
12
Spanish
English
16
Total
158
* An online survey was made available for those who were unable to participate in focus groups.
155
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Community
Based
Organization
Community
Members
#*
AIDS
Arthritis
Autism
Cancer (including prostate, and sickle cell)
Dental care
Diabetes
Heart disease
High Blood Pressure
High Cholesterol
Lack of education on healthy living
Lack of employment leading to health issues or
exacerbating existing issues
Lack of quality medical treatment
Mental health (anger management, stress, depression,
emotional health, suicide)
Multi diagnosis
Obesity (including children)
Respiratory problems (i.e. asthma, allergies)
Self medication
Specialty care
STDs
Substance abuse (i.e. marijuana)
Tobacco and alcohol
Vision issues
1
1
2
2
3
5
3
1
2
1
3
4
4
3
2
1
5
1
5
3
1
1
2
1
1
2
1
2
1
1
1
2
2
*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
there is a need for more green space for children to play and engage in physical activity, and also for community gardens that would help in
providing healthier food alternatives. With the budget cuts and the increase in health premiums, access to medical care has suffered especially
in low income communities. Also, with the high unemployment rate in their communities, there has been an increase of those needing mental
health services to treat such emotional issues as stress and depression.
Community Members. Community members identified four services that are lacking including dental, vision, and health services for the elderly
and undocumented individuals. Dental and vision services, some said, were very limited and expensive. With the increase in life expectancy
being 80.3 years of age73, the need for more health services for seniors has increased. Specifically mentioned by seniors, there is a need for
more affordable health services such as dental and vision services. Health services have become nearly impossible for undocumented individuals
to access because they are too afraid, the services are unaffordable, or they are simply denied services by providers.
Figure 139. Health services that are lacking identified by focus groups
Health services that are lacking:
Community
Based
Organization
Community
Members
#*
2
1
4
2
1
2
1
1
2
1
*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.
C. Barriers
Community Based Organization (CBOs). CBOs were asked to identify barriers that keep the community they serve from accessing health care.
The most identified barriers by CBOs include transportation, immigration status, and language barriers. Some clients do not have access to
reliable transportation or are unable to pay for public transportation. Some clients who are illegally in the country are too afraid to access
health services, especially preventative, for fear of deportation. Those who experience language barriers are unable to communicate with
health care providers in their native language, so either they do not access health care or are unable to understand and communicate with
73 73
County of Los Angeles Department of Public Health, Life Expectancy in Los Angeles County: How long do we live and why? A Cities and Communities Health Report
157
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
health care providers. Other barriers identified include not knowing where to go in their communities for information on available resources,
cultural issues such as stigmas with certain health condition such as mental health, and lack of health literacy.
Community Members. Community members were asked to identify barriers they experienced in accessing health care. All focus groups agreed
that language was the biggest barrier to accessing health care. Community members who do not speak English well or at all have an especially
difficult time communicating with health care providers about diagnosis and treatment. Transportation and not knowing where to go to learn
about available resources were the next most cited barriers by community members.
Figure 140. Barriers to health care identified by focus groups
Barriers to health care:
Community
Based
Organization
Community
Members
#*
1
2
2
1
3
2
3
1
3
1
1
1
4
2
2
1
5
1
4
2
*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.
In addition to identifying barriers, focus group participants were also asked to provide suggestions for addressing them. Please see figure 141
for suggestions.
Figure 141. How to address barriers identified, from two focus groups
Community Based Organization
Advocate for government position to help address needs/barriers
Change laws that affect access (i.e. Arizona law)
Review eligibility requirements for programs in order to allow more
people access
Decrease the price of healthcare
158
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Community Based Organization (CBOs). Community Based Organizations reported that the most difficult healthy behaviors to promote include
exercise, a healthy lifestyle, not smoking and/or drinking, and mental health. With the decrease of available green space and affordable healthy
eating options, it has become difficult for people to get physical activity or try to live a healthy lifestyle. Although it seems that smoking has
been on the decline, CBOs still note this as a difficult behavior to get people to leave behind. According to CBOs, the number of people drinking
have increased since the previous community needs assessment. That is also the case for those needing mental health services. As one CBO
stated there is a huge service gap for mental health services for everyone. Some CBOs have attributed this to the current economic situation,
particularly in low income communities that have been hardest hit with unemployment. Other behaviors are mentioned in figure xx.
Community Members. Community members also identified exercise and a healthy lifestyle as the most difficult healthy behaviors to promote in
their community. One community member mentioned that its much easier for parents to send their kids to watch TV and play video games
than to take them to the park. As previously mentioned, the availability of affordable healthy food options is also a barrier to leading a healthy
lifestyle. Please see figure 142 for other behaviors mentioned by community members.
Figure 142. Healthy behaviors hardest to promote
Healthy behaviors hardest to promote:
Community
Based
Organization
Community
Members
#*
1
1
1
1
1
1
2
2
1
1
1
159
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
*Total number of focus groups who cited the issue. Blank space indicates no focus group cited the issue.
Community Members
Preventative care (i.e. pap smears, physicals, taking vitamins)
Vaccination
Cleanliness
Eating healthy
Exercising
Community Based Organization (CBOs). CBOs identified where their clients went to obtain information on available health services. Many of the
places were in their communities such as local churches, market places (i.e. Mercado La Paloma), and community clinics. Other places where
clients obtained information included health fairs, USC Medical Center, emergency rooms, and television commercials.
Community Members. Community members also mentioned that they went to community clinics and hospitals for information on health
services. However, they also mentioned that they called 211 for information, their local WIC office, and other local center such as St. Barnabas
Senior Center and Hope Street Family Center.
160
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Community Members
211
Hope Street Family Center
WIC office
Community clinics
St. Barnabas
Hospitals (Veterans, St. Vincent, Good Samaritan)
161
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Community Members
Create low income programming (i.e. payment plans)
Provide information to the community in multiple language (i.e.
Spanish)
Mobile clinics that go out to school, parks, or other public places
Provide affordable dental and vision services
Provide quality medical services
Community Based Organization (CBOs). CBOs also mentioned other community non health issues that might impact health conditions in the
community. Most issues deal with access to such things as healthy foods, housing that is affordable and clean, sufficient food, child care,
services for foster youth, and services for returning veterans. There are also other issues that deal with the increase in violence in the
community and in the home. One CBO mentioned that the increase in domestic violence has increase since 2009 by 49%, and that studies have
shown that families facing severe economic challenges face triple rates of domestic violence.
Community Members. Community members also shared other non health issues in their communities including the increase in teenage parents,
homeless, and in the need for living assistance programs. There has also been a decrease in funding for after school and summer programs, and
funding for child care programs.
162
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
163
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
# of times mentioned*
1
1
2
1
2
4
3
2
8
1
1
1
3
1
1
3
2
1
1
1
164
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
# of times mentioned*
8
1
8
3
1
1
1
Health trends. Positive and negative health trends were noted by key informants. Positive trends included the reduction of stigmas attached to
mental health and substance abuse, an increase in emphasis on evidence based methods of treatment versus business based and a shift to
empowering consumers by providing bilingual staff and parent partners to assist. Other positive trends include:
Improvement in working with diabetes
Improvement of dermatology
Improvement of Electronic Referral Systems
More people taking personal responsibility for their health
Decrease in smoking
Population shift to 100% Latinos in some areas
More clinics and agencies opening
However, negative health trends were also noted. The most noted negative trends include the rise in obesity (particularly among Latinos and
children), those having a poor diet, diabetes (particularly among children), domestic violence, need for mental health services, decrease in those
who have health insurance (40% to 90%, as one interviewee noted), the increase in the need for specialty care, increase in job insecurity leading
to stress and fear. Other negative trends noted include:
Long waits at clinics
Alcoholism
Bed bugs
165
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
166
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
# of times mentioned*
2
1
6
2
1
4
1
1
2
1
3
1
1
1
1
167
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
C. Barriers
Key informants identified a number of barriers that their clients identified in accessing health care. The most cited barrier was transportation.
Many said that often clients did not have access to reliable transportation, could not afford public transportation, or simply live too far from
where they need to go to receive services. Other barriers identified were language barriers and the inability to access health care services. The
ability to communicate with a health care provider is difficult for those individuals that do not speak and understand English well or at all. This
has become more of an issue with the influx of immigrants in recent years. In addition to language barriers, access to health care services in
general, have become more difficult because of overcrowding, limited hours of operation or long wait times. Additional barriers mentioned
include cultural barriers such as stigmas attached to certain conditions (i.e. mental health), immigration status creating fear or stress in obtaining
services, the affordability of health care services especially for the unemployed that have limited economic resources, and the lack of health
insurance. Additional barriers are listed in Figure 149.
When key informants were asked who were the most affected by these barriers, they said that the poor, men, immigrants (especially the
undocumented), working people, the uninsured, seniors, adults, and families with children were the most affected.
Figure 149. Barriers to health care services identified by key informants
Health needs identified:
Transportation
Language barrier
Access to health care services (overcrowding, limited hours, long wait times)
Cultural barriers (i.e. stigmas)
Immigration issues
Affordability of services, esp. for unemployed
Lack of health insurance , esp. adults
Dont know where to go to learn about available resources
Lack of health education
Bureaucracy in working with government agencies when trying to provide
services
Lack of trust of the health care system (dont know the system)/providers
Lack access to child day care
Cultural competency
Going abroad for affordable health services
# of times mentioned*
14
10
10
9
9
8
7
5
4
3
3
3
2
1
168
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
# of times mentioned*
1
1
169
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
Galili
San Judas
Medical home
San Miguel
Queenscare
Hudson
Eisner
Amanecer
Clinica Romero
Childrens Institute
Chronic and specialty care services. Those that need treatment for chronic health issues may sometimes have access to private doctors, but
more often people tend to go to community clinics or county hospitals to access emergency rooms or as part of the referral process. Key
informants reported that some people use other ways to deal with their chronic health issues including using eastern medicine, an unlicensed
provider, or simply choose to deal with the issues on their own and self medicate. However, when dealing with particular issues such as mental
health, some key informants mentioned that it has become increasingly difficult to refer clients out because often there arent enough mental
health professionals on staff to deal with the increasing number of people needing these types of specialty services. Individuals that have a
primary care provider through private insurance are able to obtain referrals for specialty care much easier that those without private insurance.
170
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
F. Assets
Despite all the issues mentioned by key informants, there have been some positive strides to addressing those issues. There has been an
increase in the amount of health related information and education provided to the community at large. Promotoras and community members
that have taken a leadership role have been crucial to the dissemination of information as they are more in sync with the community and their
needs. This has also increased the communitys involvement through health fairs. At the provider level, there have been increases in the
number of facilities open to provide services, early intervention programs for children have been created, there is more case management to
connect people to the appropriate services and programs, there has been an increase in free testing and screenings made available, there has
171
Los Angeles Metropolitan Hospital Collaborative SB 697 Community Health Needs Assessment 2010
also been an increase in the importance of being culturally sensitive (many organizations are ethnic specific), and there has also been a shift in
focus to the medical home model.
Top 3 priorities. Key informants were asked to share what they thought the top three priorities to be addressed in the coming years. The top
three mentioned priorities were mental health (specifically stress, anxiety), obesity (for all but more specifically in children), and preventative
care. Other priorities mentioned include:
STDs (Chlamydia) (2)
Dental care (2)
Education (2)
Integrated safety net services (2)
Increase collaboration of hospitals with clinics on basic health care (2)
Diabetes
Teenage pregnancy
Asthma
Family preservation
Peptic cancer
Vision care
Substance abuse
In addition, key informants were asked what they felt were some social barriers affecting the top three priorities. They mentioned
gentrification, slum housing, increased poverty, disparity between patients with complex medical needs, increase in gang activity and crime,
increase in domestic violence, and the lack of affordable child care particularly in homes where both parents work.
Best ways to provide information to the community. According to key informants, the best ways to provide health related information to the
community are through marketing (smart messaging), community events such as fairs, and having convenings with both community members
and providers where information and education can be provided. In addition, it would be important to leverage exiting partnerships with
community based resources such as churches to make connections with the community. It would also be useful to provide information and
education in other languages aside from English, and to have culturally competent staff members that are able to communicate appropriately.
172